"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|FIRST HEALTH [1375]|QUALCHOICE [137513]|3633.60||||3633.60|3270.24|3270.24|763.06
100000|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|AXLE FEMORAL KNEE MODULAR ROTATE HINGE|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|3633.60||||3633.60|2361.84|3270.24|763.06
100000|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|AXLE FEMORAL KNEE MODULAR ROTATE HINGE|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|3633.60||||3633.60|3270.24|3270.24|763.06
100000|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|AXLE FEMORAL KNEE MODULAR ROTATE HINGE|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|3633.60||||3633.60|3270.24|3270.24|763.06
100000|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|AXLE FEMORAL KNEE MODULAR ROTATE HINGE|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|3633.60||||3633.60|3270.24|3270.24|763.06
100000|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|AXLE FEMORAL KNEE MODULAR ROTATE HINGE|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|3633.60||||3633.60|1159.12|3270.24|763.06
100000|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|AXLE FEMORAL KNEE MODULAR ROTATE HINGE|CORESOURCE [1315]|CORESOURCE [131500]|3633.60||||3633.60|3270.24|3270.24|763.06
100000|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|AXLE FEMORAL KNEE MODULAR ROTATE HINGE|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|3633.60||||3633.60|3270.24|3270.24|763.06
100000|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|AXLE FEMORAL KNEE MODULAR ROTATE HINGE|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|3633.60||||3633.60|2103.85|3270.24|763.06
100000|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|AXLE FEMORAL KNEE MODULAR ROTATE HINGE|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|3633.60||||3633.60|3270.24|3270.24|763.06
100000|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|AXLE FEMORAL KNEE MODULAR ROTATE HINGE|MULTIPLAN [1680]|IHC HS [168011]|3633.60||||3633.60|3270.24|3270.24|763.06
100000|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|AXLE FEMORAL KNEE MODULAR ROTATE HINGE|TRUSTMARK [2030]|STARMARK [203000]|3633.60||||3633.60|3270.24|3270.24|763.06
100000|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|AXLE FEMORAL KNEE MODULAR ROTATE HINGE|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|3633.60||||3633.60|2361.84|3270.24|763.06
100000|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|AXLE FEMORAL KNEE MODULAR ROTATE HINGE|AETNA [1015]|AETNA ACO WILCO [101532]|3633.60||||3633.60|1271.76|3270.24|763.06
100000|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|AXLE FEMORAL KNEE MODULAR ROTATE HINGE|GROUP PENSION ADMIN [1450]|GPA [145000]|3633.60||||3633.60|2543.52|3270.24|763.06
100000|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|AXLE FEMORAL KNEE MODULAR ROTATE HINGE|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|3633.60||||3633.60|3270.24|3270.24|763.06
100000|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|AXLE FEMORAL KNEE MODULAR ROTATE HINGE|CIGNA [1260]|CIGNA - GREAT WEST [126009]|3633.60||||3633.60|2543.52|3270.24|763.06
100000|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|AXLE FEMORAL KNEE MODULAR ROTATE HINGE|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|3633.60||||3633.60|3270.24|3270.24|763.06
100000|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|AXLE FEMORAL KNEE MODULAR ROTATE HINGE|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|3633.60||||3633.60|2797.87|3270.24|763.06
100000|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|AXLE FEMORAL KNEE MODULAR ROTATE HINGE|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|3633.60||||3633.60|1787.73|3270.24|763.06
100000|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|AXLE FEMORAL KNEE MODULAR ROTATE HINGE|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|3633.60||||3633.60|3270.24|3270.24|763.06
100000|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|AXLE FEMORAL KNEE MODULAR ROTATE HINGE|MULTIPLAN [1680]|HMA [168003]|3633.60||||3633.60|1271.76|3270.24|763.06
100000|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|AXLE FEMORAL KNEE MODULAR ROTATE HINGE|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|3633.60||||3633.60|1816.8|3270.24|763.06
100000|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|AXLE FEMORAL KNEE MODULAR ROTATE HINGE|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|3633.60||||3633.60|3270.24|3270.24|763.06
100000|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|AXLE FEMORAL KNEE MODULAR ROTATE HINGE|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|3633.60||||3633.60|3270.24|3270.24|763.06
100000|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|AXLE FEMORAL KNEE MODULAR ROTATE HINGE|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|3633.60||||3633.60|1471.61|3270.24|763.06
100000|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|AXLE FEMORAL KNEE MODULAR ROTATE HINGE|<Self-pay>|<Self-pay>|3633.60||||3633.60|1090.08|3270.24|763.06
100000|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|AXLE FEMORAL KNEE MODULAR ROTATE HINGE|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|3633.60||||3633.60|2361.84|3270.24|763.06
100000|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|AXLE FEMORAL KNEE MODULAR ROTATE HINGE|AETNA [1015]|COVENTRY HEALTHCARE [101502]|3633.60||||3633.60|3270.24|3270.24|763.06
100000|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|AXLE FEMORAL KNEE MODULAR ROTATE HINGE|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|3633.60||||3633.60|1562.45|3270.24|763.06
100000|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|AXLE FEMORAL KNEE MODULAR ROTATE HINGE|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|3633.60||||3633.60|3270.24|3270.24|763.06
100000|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|AXLE FEMORAL KNEE MODULAR ROTATE HINGE|SAMBA HEALTH [2305]|SAMBA HEALTH [230500]|3633.60||||3633.60|2543.52|3270.24|763.06
100000|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|AXLE FEMORAL KNEE MODULAR ROTATE HINGE|HEALTHNET [1495]|HEALTHNET [149500]|3633.60||||3633.60|3270.24|3270.24|763.06
100000|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|AXLE FEMORAL KNEE MODULAR ROTATE HINGE|AETNA [1015]|AMERICAN CONTINENTAL [101507]|3633.60||||3633.60|2543.52|3270.24|763.06
100000|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|AXLE FEMORAL KNEE MODULAR ROTATE HINGE|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|3633.60||||3633.60|3270.24|3270.24|763.06
100000|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|AXLE FEMORAL KNEE MODULAR ROTATE HINGE|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|3633.60||||3633.60|1199.09|3270.24|763.06
100000|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|AXLE FEMORAL KNEE MODULAR ROTATE HINGE|FIRST HEALTH [1375]|BENVEO/UCS [137512]|3633.60||||3633.60|3088.56|3270.24|763.06
100000|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|AXLE FEMORAL KNEE MODULAR ROTATE HINGE|FMH BENEFIT SERVICES [1390]|FMH [139000]|3633.60||||3633.60|3270.24|3270.24|763.06
100000|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|AXLE FEMORAL KNEE MODULAR ROTATE HINGE|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|3633.60||||3633.60|763.06|3270.24|763.06
100000|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|AXLE FEMORAL KNEE MODULAR ROTATE HINGE|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|3633.60||||3633.60|3270.24|3270.24|763.06
100000|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|AXLE FEMORAL KNEE MODULAR ROTATE HINGE|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|3633.60||||3633.60|1816.8|3270.24|763.06
100000|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|AXLE FEMORAL KNEE MODULAR ROTATE HINGE|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|3633.60||||3633.60|3270.24|3270.24|763.06
100000|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|AXLE FEMORAL KNEE MODULAR ROTATE HINGE|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|3633.60||||3633.60|3270.24|3270.24|763.06
100000|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|AXLE FEMORAL KNEE MODULAR ROTATE HINGE|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|3633.60||||3633.60|1271.76|3270.24|763.06
100000|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|AXLE FEMORAL KNEE MODULAR ROTATE HINGE|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|3633.60||||3633.60|1562.45|3270.24|763.06
100000|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|AXLE FEMORAL KNEE MODULAR ROTATE HINGE|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|3633.60||||3633.60|1271.76|3270.24|763.06
100000|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|AXLE FEMORAL KNEE MODULAR ROTATE HINGE|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|3633.60||||3633.60|||
100000|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|AXLE FEMORAL KNEE MODULAR ROTATE HINGE|GEHA [1415]|GEHA - ASA [141503]|3633.60||||3633.60|||
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]|3633.60||||3633.60|||
100000|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|AXLE FEMORAL KNEE MODULAR ROTATE HINGE|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|3633.60||||3633.60|||
100000|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|AXLE FEMORAL KNEE MODULAR ROTATE HINGE|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|3633.60||||3633.60|||
100000|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|AXLE FEMORAL KNEE MODULAR ROTATE HINGE|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|3633.60||||3633.60|||
100000|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|AXLE FEMORAL KNEE MODULAR ROTATE HINGE|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|3633.60||||3633.60|||
100000|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|AXLE FEMORAL KNEE MODULAR ROTATE HINGE|UMR [2035]|UMR OPTIONS [203501]|3633.60||||3633.60|||
100000|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|AXLE FEMORAL KNEE MODULAR ROTATE HINGE|CHAMPVA [1240]|CHAMP VA [124000]|3633.60||||3633.60|||
100000|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|AXLE FEMORAL KNEE MODULAR ROTATE HINGE|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|3633.60||||3633.60|||
100000|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|AXLE FEMORAL KNEE MODULAR ROTATE HINGE|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|3633.60||||3633.60|||
100000|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|AXLE FEMORAL KNEE MODULAR ROTATE HINGE|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|3633.60||||3633.60|||
100000|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|AXLE FEMORAL KNEE MODULAR ROTATE HINGE|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|3633.60||||3633.60|||
100000|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|AXLE FEMORAL KNEE MODULAR ROTATE HINGE|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|3633.60||||3633.60|||
100000|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|AXLE FEMORAL KNEE MODULAR ROTATE HINGE|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|3633.60||||3633.60|||
100000|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|AXLE FEMORAL KNEE MODULAR ROTATE HINGE|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|3633.60||||3633.60|||
100000|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|AXLE FEMORAL KNEE MODULAR ROTATE HINGE|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|3633.60||||3633.60|||
100000|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|AXLE FEMORAL KNEE MODULAR ROTATE HINGE|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|3633.60||||3633.60|||
100000|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|AXLE FEMORAL KNEE MODULAR ROTATE HINGE|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|3633.60||||3633.60|||
100000|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|AXLE FEMORAL KNEE MODULAR ROTATE HINGE|UNITED HEALTHCARE [2060]|UHC MEDICA CHOICE [206030]|3633.60||||3633.60|||
100000|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|AXLE FEMORAL KNEE MODULAR ROTATE HINGE|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|3633.60||||3633.60|||
100000|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|AXLE FEMORAL KNEE MODULAR ROTATE HINGE|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|3633.60||||3633.60|||
100000|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|AXLE FEMORAL KNEE MODULAR ROTATE HINGE|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|3633.60||||3633.60|||
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]|3633.60||||3633.60|||
100000|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|AXLE FEMORAL KNEE MODULAR ROTATE HINGE|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|3633.60||||3633.60|||
100019|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 127 D 4 33 MM OFFSET L100 MM OD8.1 MM HIP CEMENT CONDYLAR STABILIZE|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|5428.00||||5428.00|4885.2|4885.2|1139.88
100019|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 127 D 4 33 MM OFFSET L100 MM OD8.1 MM HIP CEMENT CONDYLAR STABILIZE|MULTIPLAN [1680]|IHC HS [168011]|5428.00||||5428.00|4885.2|4885.2|1139.88
100019|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 127 D 4 33 MM OFFSET L100 MM OD8.1 MM HIP CEMENT CONDYLAR STABILIZE|AETNA [1015]|COVENTRY HEALTHCARE [101502]|5428.00||||5428.00|4885.2|4885.2|1139.88
100019|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 127 D 4 33 MM OFFSET L100 MM OD8.1 MM HIP CEMENT CONDYLAR STABILIZE|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|5428.00||||5428.00|4885.2|4885.2|1139.88
100019|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 127 D 4 33 MM OFFSET L100 MM OD8.1 MM HIP CEMENT CONDYLAR STABILIZE|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|5428.00||||5428.00|4885.2|4885.2|1139.88
100019|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 127 D 4 33 MM OFFSET L100 MM OD8.1 MM HIP CEMENT CONDYLAR STABILIZE|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|5428.00||||5428.00|1899.8|4885.2|1139.88
100019|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 127 D 4 33 MM OFFSET L100 MM OD8.1 MM HIP CEMENT CONDYLAR STABILIZE|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|5428.00||||5428.00|3142.81|4885.2|1139.88
100019|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 127 D 4 33 MM OFFSET L100 MM OD8.1 MM HIP CEMENT CONDYLAR STABILIZE|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|5428.00||||5428.00|3528.2|4885.2|1139.88
100019|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 127 D 4 33 MM OFFSET L100 MM OD8.1 MM HIP CEMENT CONDYLAR STABILIZE|AETNA [1015]|AMERICAN CONTINENTAL [101507]|5428.00||||5428.00|3799.6|4885.2|1139.88
100019|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 127 D 4 33 MM OFFSET L100 MM OD8.1 MM HIP CEMENT CONDYLAR STABILIZE|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|5428.00||||5428.00|1899.8|4885.2|1139.88
100019|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 127 D 4 33 MM OFFSET L100 MM OD8.1 MM HIP CEMENT CONDYLAR STABILIZE|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|5428.00||||5428.00|3528.2|4885.2|1139.88
100019|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 127 D 4 33 MM OFFSET L100 MM OD8.1 MM HIP CEMENT CONDYLAR STABILIZE|AETNA [1015]|AETNA ACO WILCO [101532]|5428.00||||5428.00|1899.8|4885.2|1139.88
100019|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 127 D 4 33 MM OFFSET L100 MM OD8.1 MM HIP CEMENT CONDYLAR STABILIZE|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|5428.00||||5428.00|4885.2|4885.2|1139.88
100019|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 127 D 4 33 MM OFFSET L100 MM OD8.1 MM HIP CEMENT CONDYLAR STABILIZE|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|5428.00||||5428.00|4885.2|4885.2|1139.88
100019|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 127 D 4 33 MM OFFSET L100 MM OD8.1 MM HIP CEMENT CONDYLAR STABILIZE|<Self-pay>|<Self-pay>|5428.00||||5428.00|1628.4|4885.2|1139.88
100019|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 127 D 4 33 MM OFFSET L100 MM OD8.1 MM HIP CEMENT CONDYLAR STABILIZE|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|5428.00||||5428.00|2670.58|4885.2|1139.88
100019|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 127 D 4 33 MM OFFSET L100 MM OD8.1 MM HIP CEMENT CONDYLAR STABILIZE|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|5428.00||||5428.00|3528.2|4885.2|1139.88
100019|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 127 D 4 33 MM OFFSET L100 MM OD8.1 MM HIP CEMENT CONDYLAR STABILIZE|HEALTHNET [1495]|HEALTHNET [149500]|5428.00||||5428.00|4885.2|4885.2|1139.88
100019|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 127 D 4 33 MM OFFSET L100 MM OD8.1 MM HIP CEMENT CONDYLAR STABILIZE|MULTIPLAN [1680]|HMA [168003]|5428.00||||5428.00|1899.8|4885.2|1139.88
100019|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 127 D 4 33 MM OFFSET L100 MM OD8.1 MM HIP CEMENT CONDYLAR STABILIZE|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|5428.00||||5428.00|4179.56|4885.2|1139.88
100019|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 127 D 4 33 MM OFFSET L100 MM OD8.1 MM HIP CEMENT CONDYLAR STABILIZE|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|5428.00||||5428.00|1731.53|4885.2|1139.88
100019|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 127 D 4 33 MM OFFSET L100 MM OD8.1 MM HIP CEMENT CONDYLAR STABILIZE|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|5428.00||||5428.00|1791.24|4885.2|1139.88
100019|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 127 D 4 33 MM OFFSET L100 MM OD8.1 MM HIP CEMENT CONDYLAR STABILIZE|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|5428.00||||5428.00|4885.2|4885.2|1139.88
100019|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 127 D 4 33 MM OFFSET L100 MM OD8.1 MM HIP CEMENT CONDYLAR STABILIZE|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|5428.00||||5428.00|4885.2|4885.2|1139.88
100019|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 127 D 4 33 MM OFFSET L100 MM OD8.1 MM HIP CEMENT CONDYLAR STABILIZE|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|5428.00||||5428.00|2334.04|4885.2|1139.88
100019|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 127 D 4 33 MM OFFSET L100 MM OD8.1 MM HIP CEMENT CONDYLAR STABILIZE|FMH BENEFIT SERVICES [1390]|FMH [139000]|5428.00||||5428.00|4885.2|4885.2|1139.88
100019|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 127 D 4 33 MM OFFSET L100 MM OD8.1 MM HIP CEMENT CONDYLAR STABILIZE|CIGNA [1260]|CIGNA - GREAT WEST [126009]|5428.00||||5428.00|3799.6|4885.2|1139.88
100019|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 127 D 4 33 MM OFFSET L100 MM OD8.1 MM HIP CEMENT CONDYLAR STABILIZE|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|5428.00||||5428.00|1139.88|4885.2|1139.88
100019|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 127 D 4 33 MM OFFSET L100 MM OD8.1 MM HIP CEMENT CONDYLAR STABILIZE|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|5428.00||||5428.00|4885.2|4885.2|1139.88
100019|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 127 D 4 33 MM OFFSET L100 MM OD8.1 MM HIP CEMENT CONDYLAR STABILIZE|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|5428.00||||5428.00|4885.2|4885.2|1139.88
100019|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 127 D 4 33 MM OFFSET L100 MM OD8.1 MM HIP CEMENT CONDYLAR STABILIZE|GROUP PENSION ADMIN [1450]|GPA [145000]|5428.00||||5428.00|3799.6|4885.2|1139.88
100019|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 127 D 4 33 MM OFFSET L100 MM OD8.1 MM HIP CEMENT CONDYLAR STABILIZE|CORESOURCE [1315]|CORESOURCE [131500]|5428.00||||5428.00|4885.2|4885.2|1139.88
100019|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 127 D 4 33 MM OFFSET L100 MM OD8.1 MM HIP CEMENT CONDYLAR STABILIZE|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|5428.00||||5428.00|2714|4885.2|1139.88
100019|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 127 D 4 33 MM OFFSET L100 MM OD8.1 MM HIP CEMENT CONDYLAR STABILIZE|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|5428.00||||5428.00|4885.2|4885.2|1139.88
100019|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 127 D 4 33 MM OFFSET L100 MM OD8.1 MM HIP CEMENT CONDYLAR STABILIZE|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|5428.00||||5428.00|2714|4885.2|1139.88
100019|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 127 D 4 33 MM OFFSET L100 MM OD8.1 MM HIP CEMENT CONDYLAR STABILIZE|FIRST HEALTH [1375]|QUALCHOICE [137513]|5428.00||||5428.00|4885.2|4885.2|1139.88
100019|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 127 D 4 33 MM OFFSET L100 MM OD8.1 MM HIP CEMENT CONDYLAR STABILIZE|TRUSTMARK [2030]|STARMARK [203000]|5428.00||||5428.00|4885.2|4885.2|1139.88
100019|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 127 D 4 33 MM OFFSET L100 MM OD8.1 MM HIP CEMENT CONDYLAR STABILIZE|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|5428.00||||5428.00|4885.2|4885.2|1139.88
100019|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 127 D 4 33 MM OFFSET L100 MM OD8.1 MM HIP CEMENT CONDYLAR STABILIZE|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|5428.00||||5428.00|4885.2|4885.2|1139.88
100019|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 127 D 4 33 MM OFFSET L100 MM OD8.1 MM HIP CEMENT CONDYLAR STABILIZE|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|5428.00||||5428.00|4885.2|4885.2|1139.88
100019|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 127 D 4 33 MM OFFSET L100 MM OD8.1 MM HIP CEMENT CONDYLAR STABILIZE|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|5428.00||||5428.00|2334.04|4885.2|1139.88
100019|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 127 D 4 33 MM OFFSET L100 MM OD8.1 MM HIP CEMENT CONDYLAR STABILIZE|FIRST HEALTH [1375]|BENVEO/UCS [137512]|5428.00||||5428.00|4613.8|4885.2|1139.88
100019|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 127 D 4 33 MM OFFSET L100 MM OD8.1 MM HIP CEMENT CONDYLAR STABILIZE|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|5428.00||||5428.00|4885.2|4885.2|1139.88
100019|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 127 D 4 33 MM OFFSET L100 MM OD8.1 MM HIP CEMENT CONDYLAR STABILIZE|SAMBA HEALTH [2305]|SAMBA HEALTH [230500]|5428.00||||5428.00|3799.6|4885.2|1139.88
100019|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 127 D 4 33 MM OFFSET L100 MM OD8.1 MM HIP CEMENT CONDYLAR STABILIZE|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|5428.00||||5428.00|2198.34|4885.2|1139.88
100019|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 127 D 4 33 MM OFFSET L100 MM OD8.1 MM HIP CEMENT CONDYLAR STABILIZE|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|5428.00||||5428.00|4885.2|4885.2|1139.88
100019|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 127 D 4 33 MM OFFSET L100 MM OD8.1 MM HIP CEMENT CONDYLAR STABILIZE|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|5428.00||||5428.00|||
100019|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 127 D 4 33 MM OFFSET L100 MM OD8.1 MM HIP CEMENT CONDYLAR STABILIZE|UNITED HEALTHCARE [2060]|UHC MEDICA CHOICE [206030]|5428.00||||5428.00|||
100019|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 127 D 4 33 MM OFFSET L100 MM OD8.1 MM HIP CEMENT CONDYLAR STABILIZE|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|5428.00||||5428.00|||
100019|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 127 D 4 33 MM OFFSET L100 MM OD8.1 MM HIP CEMENT CONDYLAR STABILIZE|GEHA [1415]|GEHA - ASA [141503]|5428.00||||5428.00|||
100019|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 127 D 4 33 MM OFFSET L100 MM OD8.1 MM HIP CEMENT CONDYLAR STABILIZE|CHAMPVA [1240]|CHAMP VA [124000]|5428.00||||5428.00|||
100019|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 127 D 4 33 MM OFFSET L100 MM OD8.1 MM HIP CEMENT CONDYLAR STABILIZE|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|5428.00||||5428.00|||
100019|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 127 D 4 33 MM OFFSET L100 MM OD8.1 MM HIP CEMENT CONDYLAR STABILIZE|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|5428.00||||5428.00|||
100019|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 127 D 4 33 MM OFFSET L100 MM OD8.1 MM HIP CEMENT CONDYLAR STABILIZE|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|5428.00||||5428.00|||
100019|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 127 D 4 33 MM OFFSET L100 MM OD8.1 MM HIP CEMENT CONDYLAR STABILIZE|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|5428.00||||5428.00|||
100019|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 127 D 4 33 MM OFFSET L100 MM OD8.1 MM HIP CEMENT CONDYLAR STABILIZE|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|5428.00||||5428.00|||
100019|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 127 D 4 33 MM OFFSET L100 MM OD8.1 MM HIP CEMENT CONDYLAR STABILIZE|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|5428.00||||5428.00|||
100019|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 127 D 4 33 MM OFFSET L100 MM OD8.1 MM HIP CEMENT CONDYLAR STABILIZE|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|5428.00||||5428.00|||
100019|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 127 D 4 33 MM OFFSET L100 MM OD8.1 MM HIP CEMENT CONDYLAR STABILIZE|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|5428.00||||5428.00|||
100019|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 127 D 4 33 MM OFFSET L100 MM OD8.1 MM HIP CEMENT CONDYLAR STABILIZE|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|5428.00||||5428.00|||
100019|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 127 D 4 33 MM OFFSET L100 MM OD8.1 MM HIP CEMENT CONDYLAR STABILIZE|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|5428.00||||5428.00|||
100019|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 127 D 4 33 MM OFFSET L100 MM OD8.1 MM HIP CEMENT CONDYLAR STABILIZE|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|5428.00||||5428.00|||
100019|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 127 D 4 33 MM OFFSET L100 MM OD8.1 MM HIP CEMENT CONDYLAR STABILIZE|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|5428.00||||5428.00|||
100019|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 127 D 4 33 MM OFFSET L100 MM OD8.1 MM HIP CEMENT CONDYLAR STABILIZE|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|5428.00||||5428.00|||
100019|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 127 D 4 33 MM OFFSET L100 MM OD8.1 MM HIP CEMENT CONDYLAR STABILIZE|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|5428.00||||5428.00|||
100019|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 127 D 4 33 MM OFFSET L100 MM OD8.1 MM HIP CEMENT CONDYLAR STABILIZE|UMR [2035]|UMR OPTIONS [203501]|5428.00||||5428.00|||
100019|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 127 D 4 33 MM OFFSET L100 MM OD8.1 MM HIP CEMENT CONDYLAR STABILIZE|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|5428.00||||5428.00|||
100019|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 127 D 4 33 MM OFFSET L100 MM OD8.1 MM HIP CEMENT CONDYLAR STABILIZE|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|5428.00||||5428.00|||
100019|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 127 D 4 33 MM OFFSET L100 MM OD8.1 MM HIP CEMENT CONDYLAR STABILIZE|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|5428.00||||5428.00|||
100019|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 127 D 4 33 MM OFFSET L100 MM OD8.1 MM HIP CEMENT CONDYLAR STABILIZE|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|5428.00||||5428.00|||
100019|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 127 D 4 33 MM OFFSET L100 MM OD8.1 MM HIP CEMENT CONDYLAR STABILIZE|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|5428.00||||5428.00|||
100022|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 127 D 7 45 MM OFFSET L130 MM OD10.4 MM HIP CEMENT CONDYLAR STABILIZE|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|5428.00||||5428.00|4885.2|4885.2|1139.88
100022|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 127 D 7 45 MM OFFSET L130 MM OD10.4 MM HIP CEMENT CONDYLAR STABILIZE|FMH BENEFIT SERVICES [1390]|FMH [139000]|5428.00||||5428.00|4885.2|4885.2|1139.88
100022|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 127 D 7 45 MM OFFSET L130 MM OD10.4 MM HIP CEMENT CONDYLAR STABILIZE|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|5428.00||||5428.00|2714|4885.2|1139.88
100022|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 127 D 7 45 MM OFFSET L130 MM OD10.4 MM HIP CEMENT CONDYLAR STABILIZE|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|5428.00||||5428.00|2714|4885.2|1139.88
100022|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 127 D 7 45 MM OFFSET L130 MM OD10.4 MM HIP CEMENT CONDYLAR STABILIZE|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|5428.00||||5428.00|4885.2|4885.2|1139.88
100022|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 127 D 7 45 MM OFFSET L130 MM OD10.4 MM HIP CEMENT CONDYLAR STABILIZE|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|5428.00||||5428.00|1791.24|4885.2|1139.88
100022|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 127 D 7 45 MM OFFSET L130 MM OD10.4 MM HIP CEMENT CONDYLAR STABILIZE|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|5428.00||||5428.00|4885.2|4885.2|1139.88
100022|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 127 D 7 45 MM OFFSET L130 MM OD10.4 MM HIP CEMENT CONDYLAR STABILIZE|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|5428.00||||5428.00|1139.88|4885.2|1139.88
100022|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 127 D 7 45 MM OFFSET L130 MM OD10.4 MM HIP CEMENT CONDYLAR STABILIZE|CIGNA [1260]|CIGNA - GREAT WEST [126009]|5428.00||||5428.00|3799.6|4885.2|1139.88
100022|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 127 D 7 45 MM OFFSET L130 MM OD10.4 MM HIP CEMENT CONDYLAR STABILIZE|HEALTHNET [1495]|HEALTHNET [149500]|5428.00||||5428.00|4885.2|4885.2|1139.88
100022|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 127 D 7 45 MM OFFSET L130 MM OD10.4 MM HIP CEMENT CONDYLAR STABILIZE|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|5428.00||||5428.00|3528.2|4885.2|1139.88
100022|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 127 D 7 45 MM OFFSET L130 MM OD10.4 MM HIP CEMENT CONDYLAR STABILIZE|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|5428.00||||5428.00|4885.2|4885.2|1139.88
100022|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 127 D 7 45 MM OFFSET L130 MM OD10.4 MM HIP CEMENT CONDYLAR STABILIZE|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|5428.00||||5428.00|1899.8|4885.2|1139.88
100022|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 127 D 7 45 MM OFFSET L130 MM OD10.4 MM HIP CEMENT CONDYLAR STABILIZE|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|5428.00||||5428.00|4885.2|4885.2|1139.88
100022|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 127 D 7 45 MM OFFSET L130 MM OD10.4 MM HIP CEMENT CONDYLAR STABILIZE|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|5428.00||||5428.00|4885.2|4885.2|1139.88
100022|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 127 D 7 45 MM OFFSET L130 MM OD10.4 MM HIP CEMENT CONDYLAR STABILIZE|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|5428.00||||5428.00|4885.2|4885.2|1139.88
100022|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 127 D 7 45 MM OFFSET L130 MM OD10.4 MM HIP CEMENT CONDYLAR STABILIZE|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|5428.00||||5428.00|4885.2|4885.2|1139.88
100022|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 127 D 7 45 MM OFFSET L130 MM OD10.4 MM HIP CEMENT CONDYLAR STABILIZE|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|5428.00||||5428.00|1731.53|4885.2|1139.88
100022|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 127 D 7 45 MM OFFSET L130 MM OD10.4 MM HIP CEMENT CONDYLAR STABILIZE|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|5428.00||||5428.00|4179.56|4885.2|1139.88
100022|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 127 D 7 45 MM OFFSET L130 MM OD10.4 MM HIP CEMENT CONDYLAR STABILIZE|AETNA [1015]|AETNA ACO WILCO [101532]|5428.00||||5428.00|1899.8|4885.2|1139.88
100022|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 127 D 7 45 MM OFFSET L130 MM OD10.4 MM HIP CEMENT CONDYLAR STABILIZE|AETNA [1015]|COVENTRY HEALTHCARE [101502]|5428.00||||5428.00|4885.2|4885.2|1139.88
100022|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 127 D 7 45 MM OFFSET L130 MM OD10.4 MM HIP CEMENT CONDYLAR STABILIZE|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|5428.00||||5428.00|4885.2|4885.2|1139.88
100022|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 127 D 7 45 MM OFFSET L130 MM OD10.4 MM HIP CEMENT CONDYLAR STABILIZE|CORESOURCE [1315]|CORESOURCE [131500]|5428.00||||5428.00|4885.2|4885.2|1139.88
100022|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 127 D 7 45 MM OFFSET L130 MM OD10.4 MM HIP CEMENT CONDYLAR STABILIZE|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|5428.00||||5428.00|4885.2|4885.2|1139.88
100022|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 127 D 7 45 MM OFFSET L130 MM OD10.4 MM HIP CEMENT CONDYLAR STABILIZE|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|5428.00||||5428.00|3528.2|4885.2|1139.88
100022|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 127 D 7 45 MM OFFSET L130 MM OD10.4 MM HIP CEMENT CONDYLAR STABILIZE|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|5428.00||||5428.00|1899.8|4885.2|1139.88
100022|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 127 D 7 45 MM OFFSET L130 MM OD10.4 MM HIP CEMENT CONDYLAR STABILIZE|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|5428.00||||5428.00|4885.2|4885.2|1139.88
100022|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 127 D 7 45 MM OFFSET L130 MM OD10.4 MM HIP CEMENT CONDYLAR STABILIZE|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|5428.00||||5428.00|2334.04|4885.2|1139.88
100022|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 127 D 7 45 MM OFFSET L130 MM OD10.4 MM HIP CEMENT CONDYLAR STABILIZE|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|5428.00||||5428.00|2198.34|4885.2|1139.88
100022|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 127 D 7 45 MM OFFSET L130 MM OD10.4 MM HIP CEMENT CONDYLAR STABILIZE|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|5428.00||||5428.00|2334.04|4885.2|1139.88
100022|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 127 D 7 45 MM OFFSET L130 MM OD10.4 MM HIP CEMENT CONDYLAR STABILIZE|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|5428.00||||5428.00|2670.58|4885.2|1139.88
100022|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 127 D 7 45 MM OFFSET L130 MM OD10.4 MM HIP CEMENT CONDYLAR STABILIZE|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|5428.00||||5428.00|4885.2|4885.2|1139.88
100022|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 127 D 7 45 MM OFFSET L130 MM OD10.4 MM HIP CEMENT CONDYLAR STABILIZE|AETNA [1015]|AMERICAN CONTINENTAL [101507]|5428.00||||5428.00|3799.6|4885.2|1139.88
100022|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 127 D 7 45 MM OFFSET L130 MM OD10.4 MM HIP CEMENT CONDYLAR STABILIZE|<Self-pay>|<Self-pay>|5428.00||||5428.00|1628.4|4885.2|1139.88
100022|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 127 D 7 45 MM OFFSET L130 MM OD10.4 MM HIP CEMENT CONDYLAR STABILIZE|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|5428.00||||5428.00|3528.2|4885.2|1139.88
100022|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 127 D 7 45 MM OFFSET L130 MM OD10.4 MM HIP CEMENT CONDYLAR STABILIZE|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|5428.00||||5428.00|4885.2|4885.2|1139.88
100022|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 127 D 7 45 MM OFFSET L130 MM OD10.4 MM HIP CEMENT CONDYLAR STABILIZE|FIRST HEALTH [1375]|BENVEO/UCS [137512]|5428.00||||5428.00|4613.8|4885.2|1139.88
100022|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 127 D 7 45 MM OFFSET L130 MM OD10.4 MM HIP CEMENT CONDYLAR STABILIZE|FIRST HEALTH [1375]|QUALCHOICE [137513]|5428.00||||5428.00|4885.2|4885.2|1139.88
100022|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 127 D 7 45 MM OFFSET L130 MM OD10.4 MM HIP CEMENT CONDYLAR STABILIZE|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|5428.00||||5428.00|3142.81|4885.2|1139.88
100022|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 127 D 7 45 MM OFFSET L130 MM OD10.4 MM HIP CEMENT CONDYLAR STABILIZE|TRUSTMARK [2030]|STARMARK [203000]|5428.00||||5428.00|4885.2|4885.2|1139.88
100022|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 127 D 7 45 MM OFFSET L130 MM OD10.4 MM HIP CEMENT CONDYLAR STABILIZE|MULTIPLAN [1680]|IHC HS [168011]|5428.00||||5428.00|4885.2|4885.2|1139.88
100022|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 127 D 7 45 MM OFFSET L130 MM OD10.4 MM HIP CEMENT CONDYLAR STABILIZE|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|5428.00||||5428.00|4885.2|4885.2|1139.88
100022|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 127 D 7 45 MM OFFSET L130 MM OD10.4 MM HIP CEMENT CONDYLAR STABILIZE|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|5428.00||||5428.00|4885.2|4885.2|1139.88
100022|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 127 D 7 45 MM OFFSET L130 MM OD10.4 MM HIP CEMENT CONDYLAR STABILIZE|SAMBA HEALTH [2305]|SAMBA HEALTH [230500]|5428.00||||5428.00|3799.6|4885.2|1139.88
100022|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 127 D 7 45 MM OFFSET L130 MM OD10.4 MM HIP CEMENT CONDYLAR STABILIZE|GROUP PENSION ADMIN [1450]|GPA [145000]|5428.00||||5428.00|3799.6|4885.2|1139.88
100022|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 127 D 7 45 MM OFFSET L130 MM OD10.4 MM HIP CEMENT CONDYLAR STABILIZE|MULTIPLAN [1680]|HMA [168003]|5428.00||||5428.00|1899.8|4885.2|1139.88
100022|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 127 D 7 45 MM OFFSET L130 MM OD10.4 MM HIP CEMENT CONDYLAR STABILIZE|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|5428.00||||5428.00|||
100022|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 127 D 7 45 MM OFFSET L130 MM OD10.4 MM HIP CEMENT CONDYLAR STABILIZE|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|5428.00||||5428.00|||
100022|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 127 D 7 45 MM OFFSET L130 MM OD10.4 MM HIP CEMENT CONDYLAR STABILIZE|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|5428.00||||5428.00|||
100022|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 127 D 7 45 MM OFFSET L130 MM OD10.4 MM HIP CEMENT CONDYLAR STABILIZE|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|5428.00||||5428.00|||
100022|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 127 D 7 45 MM OFFSET L130 MM OD10.4 MM HIP CEMENT CONDYLAR STABILIZE|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|5428.00||||5428.00|||
100022|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 127 D 7 45 MM OFFSET L130 MM OD10.4 MM HIP CEMENT CONDYLAR STABILIZE|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|5428.00||||5428.00|||
100022|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 127 D 7 45 MM OFFSET L130 MM OD10.4 MM HIP CEMENT CONDYLAR STABILIZE|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|5428.00||||5428.00|||
100022|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 127 D 7 45 MM OFFSET L130 MM OD10.4 MM HIP CEMENT CONDYLAR STABILIZE|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|5428.00||||5428.00|||
100022|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 127 D 7 45 MM OFFSET L130 MM OD10.4 MM HIP CEMENT CONDYLAR STABILIZE|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|5428.00||||5428.00|||
100022|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 127 D 7 45 MM OFFSET L130 MM OD10.4 MM HIP CEMENT CONDYLAR STABILIZE|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|5428.00||||5428.00|||
100022|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 127 D 7 45 MM OFFSET L130 MM OD10.4 MM HIP CEMENT CONDYLAR STABILIZE|CHAMPVA [1240]|CHAMP VA [124000]|5428.00||||5428.00|||
100022|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 127 D 7 45 MM OFFSET L130 MM OD10.4 MM HIP CEMENT CONDYLAR STABILIZE|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|5428.00||||5428.00|||
100022|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 127 D 7 45 MM OFFSET L130 MM OD10.4 MM HIP CEMENT CONDYLAR STABILIZE|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|5428.00||||5428.00|||
100022|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 127 D 7 45 MM OFFSET L130 MM OD10.4 MM HIP CEMENT CONDYLAR STABILIZE|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|5428.00||||5428.00|||
100022|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 127 D 7 45 MM OFFSET L130 MM OD10.4 MM HIP CEMENT CONDYLAR STABILIZE|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|5428.00||||5428.00|||
100022|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 127 D 7 45 MM OFFSET L130 MM OD10.4 MM HIP CEMENT CONDYLAR STABILIZE|UNITED HEALTHCARE [2060]|UHC MEDICA CHOICE [206030]|5428.00||||5428.00|||
100022|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 127 D 7 45 MM OFFSET L130 MM OD10.4 MM HIP CEMENT CONDYLAR STABILIZE|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|5428.00||||5428.00|||
100022|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 127 D 7 45 MM OFFSET L130 MM OD10.4 MM HIP CEMENT CONDYLAR STABILIZE|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|5428.00||||5428.00|||
100022|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 127 D 7 45 MM OFFSET L130 MM OD10.4 MM HIP CEMENT CONDYLAR STABILIZE|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|5428.00||||5428.00|||
100022|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 127 D 7 45 MM OFFSET L130 MM OD10.4 MM HIP CEMENT CONDYLAR STABILIZE|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|5428.00||||5428.00|||
100022|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 127 D 7 45 MM OFFSET L130 MM OD10.4 MM HIP CEMENT CONDYLAR STABILIZE|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|5428.00||||5428.00|||
100022|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 127 D 7 45 MM OFFSET L130 MM OD10.4 MM HIP CEMENT CONDYLAR STABILIZE|UMR [2035]|UMR OPTIONS [203501]|5428.00||||5428.00|||
100022|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 127 D 7 45 MM OFFSET L130 MM OD10.4 MM HIP CEMENT CONDYLAR STABILIZE|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|5428.00||||5428.00|||
100022|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 127 D 7 45 MM OFFSET L130 MM OD10.4 MM HIP CEMENT CONDYLAR STABILIZE|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|5428.00||||5428.00|||
100022|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 127 D 7 45 MM OFFSET L130 MM OD10.4 MM HIP CEMENT CONDYLAR STABILIZE|GEHA [1415]|GEHA - ASA [141503]|5428.00||||5428.00|||
100023|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 127 D 8 46 MM OFFSET L135 MM OD11.3 MM HIP CEMENT CONDYLAR STABILIZE|AETNA [1015]|COVENTRY HEALTHCARE [101502]|5428.00||||5428.00|4885.2|4885.2|1139.88
100023|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 127 D 8 46 MM OFFSET L135 MM OD11.3 MM HIP CEMENT CONDYLAR STABILIZE|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|5428.00||||5428.00|2670.58|4885.2|1139.88
100023|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 127 D 8 46 MM OFFSET L135 MM OD11.3 MM HIP CEMENT CONDYLAR STABILIZE|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|5428.00||||5428.00|2198.34|4885.2|1139.88
100023|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 127 D 8 46 MM OFFSET L135 MM OD11.3 MM HIP CEMENT CONDYLAR STABILIZE|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|5428.00||||5428.00|4885.2|4885.2|1139.88
100023|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 127 D 8 46 MM OFFSET L135 MM OD11.3 MM HIP CEMENT CONDYLAR STABILIZE|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|5428.00||||5428.00|2334.04|4885.2|1139.88
100023|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 127 D 8 46 MM OFFSET L135 MM OD11.3 MM HIP CEMENT CONDYLAR STABILIZE|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|5428.00||||5428.00|1899.8|4885.2|1139.88
100023|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 127 D 8 46 MM OFFSET L135 MM OD11.3 MM HIP CEMENT CONDYLAR STABILIZE|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|5428.00||||5428.00|4885.2|4885.2|1139.88
100023|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 127 D 8 46 MM OFFSET L135 MM OD11.3 MM HIP CEMENT CONDYLAR STABILIZE|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|5428.00||||5428.00|4885.2|4885.2|1139.88
100023|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 127 D 8 46 MM OFFSET L135 MM OD11.3 MM HIP CEMENT CONDYLAR STABILIZE|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|5428.00||||5428.00|4885.2|4885.2|1139.88
100023|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 127 D 8 46 MM OFFSET L135 MM OD11.3 MM HIP CEMENT CONDYLAR STABILIZE|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|5428.00||||5428.00|4179.56|4885.2|1139.88
100023|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 127 D 8 46 MM OFFSET L135 MM OD11.3 MM HIP CEMENT CONDYLAR STABILIZE|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|5428.00||||5428.00|4885.2|4885.2|1139.88
100023|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 127 D 8 46 MM OFFSET L135 MM OD11.3 MM HIP CEMENT CONDYLAR STABILIZE|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|5428.00||||5428.00|1139.88|4885.2|1139.88
100023|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 127 D 8 46 MM OFFSET L135 MM OD11.3 MM HIP CEMENT CONDYLAR STABILIZE|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|5428.00||||5428.00|4885.2|4885.2|1139.88
100023|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 127 D 8 46 MM OFFSET L135 MM OD11.3 MM HIP CEMENT CONDYLAR STABILIZE|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|5428.00||||5428.00|1731.53|4885.2|1139.88
100023|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 127 D 8 46 MM OFFSET L135 MM OD11.3 MM HIP CEMENT CONDYLAR STABILIZE|CIGNA [1260]|CIGNA - GREAT WEST [126009]|5428.00||||5428.00|3799.6|4885.2|1139.88
100023|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 127 D 8 46 MM OFFSET L135 MM OD11.3 MM HIP CEMENT CONDYLAR STABILIZE|TRUSTMARK [2030]|STARMARK [203000]|5428.00||||5428.00|4885.2|4885.2|1139.88
100023|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 127 D 8 46 MM OFFSET L135 MM OD11.3 MM HIP CEMENT CONDYLAR STABILIZE|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|5428.00||||5428.00|3528.2|4885.2|1139.88
100023|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 127 D 8 46 MM OFFSET L135 MM OD11.3 MM HIP CEMENT CONDYLAR STABILIZE|HEALTHNET [1495]|HEALTHNET [149500]|5428.00||||5428.00|4885.2|4885.2|1139.88
100023|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 127 D 8 46 MM OFFSET L135 MM OD11.3 MM HIP CEMENT CONDYLAR STABILIZE|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|5428.00||||5428.00|3142.81|4885.2|1139.88
100023|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 127 D 8 46 MM OFFSET L135 MM OD11.3 MM HIP CEMENT CONDYLAR STABILIZE|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|5428.00||||5428.00|2334.04|4885.2|1139.88
100023|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 127 D 8 46 MM OFFSET L135 MM OD11.3 MM HIP CEMENT CONDYLAR STABILIZE|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|5428.00||||5428.00|4885.2|4885.2|1139.88
100023|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 127 D 8 46 MM OFFSET L135 MM OD11.3 MM HIP CEMENT CONDYLAR STABILIZE|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|5428.00||||5428.00|1791.24|4885.2|1139.88
100023|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 127 D 8 46 MM OFFSET L135 MM OD11.3 MM HIP CEMENT CONDYLAR STABILIZE|CORESOURCE [1315]|CORESOURCE [131500]|5428.00||||5428.00|4885.2|4885.2|1139.88
100023|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 127 D 8 46 MM OFFSET L135 MM OD11.3 MM HIP CEMENT CONDYLAR STABILIZE|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|5428.00||||5428.00|2714|4885.2|1139.88
100023|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 127 D 8 46 MM OFFSET L135 MM OD11.3 MM HIP CEMENT CONDYLAR STABILIZE|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|5428.00||||5428.00|4885.2|4885.2|1139.88
100023|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 127 D 8 46 MM OFFSET L135 MM OD11.3 MM HIP CEMENT CONDYLAR STABILIZE|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|5428.00||||5428.00|2714|4885.2|1139.88
100023|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 127 D 8 46 MM OFFSET L135 MM OD11.3 MM HIP CEMENT CONDYLAR STABILIZE|GROUP PENSION ADMIN [1450]|GPA [145000]|5428.00||||5428.00|3799.6|4885.2|1139.88
100023|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 127 D 8 46 MM OFFSET L135 MM OD11.3 MM HIP CEMENT CONDYLAR STABILIZE|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|5428.00||||5428.00|4885.2|4885.2|1139.88
100023|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 127 D 8 46 MM OFFSET L135 MM OD11.3 MM HIP CEMENT CONDYLAR STABILIZE|FMH BENEFIT SERVICES [1390]|FMH [139000]|5428.00||||5428.00|4885.2|4885.2|1139.88
100023|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 127 D 8 46 MM OFFSET L135 MM OD11.3 MM HIP CEMENT CONDYLAR STABILIZE|AETNA [1015]|AMERICAN CONTINENTAL [101507]|5428.00||||5428.00|3799.6|4885.2|1139.88
100023|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 127 D 8 46 MM OFFSET L135 MM OD11.3 MM HIP CEMENT CONDYLAR STABILIZE|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|5428.00||||5428.00|4885.2|4885.2|1139.88
100023|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 127 D 8 46 MM OFFSET L135 MM OD11.3 MM HIP CEMENT CONDYLAR STABILIZE|<Self-pay>|<Self-pay>|5428.00||||5428.00|1628.4|4885.2|1139.88
100023|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 127 D 8 46 MM OFFSET L135 MM OD11.3 MM HIP CEMENT CONDYLAR STABILIZE|FIRST HEALTH [1375]|BENVEO/UCS [137512]|5428.00||||5428.00|4613.8|4885.2|1139.88
100023|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 127 D 8 46 MM OFFSET L135 MM OD11.3 MM HIP CEMENT CONDYLAR STABILIZE|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|5428.00||||5428.00|3528.2|4885.2|1139.88
100023|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 127 D 8 46 MM OFFSET L135 MM OD11.3 MM HIP CEMENT CONDYLAR STABILIZE|FIRST HEALTH [1375]|QUALCHOICE [137513]|5428.00||||5428.00|4885.2|4885.2|1139.88
100023|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 127 D 8 46 MM OFFSET L135 MM OD11.3 MM HIP CEMENT CONDYLAR STABILIZE|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|5428.00||||5428.00|4885.2|4885.2|1139.88
100023|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 127 D 8 46 MM OFFSET L135 MM OD11.3 MM HIP CEMENT CONDYLAR STABILIZE|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|5428.00||||5428.00|4885.2|4885.2|1139.88
100023|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 127 D 8 46 MM OFFSET L135 MM OD11.3 MM HIP CEMENT CONDYLAR STABILIZE|SAMBA HEALTH [2305]|SAMBA HEALTH [230500]|5428.00||||5428.00|3799.6|4885.2|1139.88
100023|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 127 D 8 46 MM OFFSET L135 MM OD11.3 MM HIP CEMENT CONDYLAR STABILIZE|MULTIPLAN [1680]|IHC HS [168011]|5428.00||||5428.00|4885.2|4885.2|1139.88
100023|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 127 D 8 46 MM OFFSET L135 MM OD11.3 MM HIP CEMENT CONDYLAR STABILIZE|MULTIPLAN [1680]|HMA [168003]|5428.00||||5428.00|1899.8|4885.2|1139.88
100023|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 127 D 8 46 MM OFFSET L135 MM OD11.3 MM HIP CEMENT CONDYLAR STABILIZE|AETNA [1015]|AETNA ACO WILCO [101532]|5428.00||||5428.00|1899.8|4885.2|1139.88
100023|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 127 D 8 46 MM OFFSET L135 MM OD11.3 MM HIP CEMENT CONDYLAR STABILIZE|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|5428.00||||5428.00|4885.2|4885.2|1139.88
100023|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 127 D 8 46 MM OFFSET L135 MM OD11.3 MM HIP CEMENT CONDYLAR STABILIZE|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|5428.00||||5428.00|3528.2|4885.2|1139.88
100023|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 127 D 8 46 MM OFFSET L135 MM OD11.3 MM HIP CEMENT CONDYLAR STABILIZE|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|5428.00||||5428.00|4885.2|4885.2|1139.88
100023|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 127 D 8 46 MM OFFSET L135 MM OD11.3 MM HIP CEMENT CONDYLAR STABILIZE|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|5428.00||||5428.00|1899.8|4885.2|1139.88
100023|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 127 D 8 46 MM OFFSET L135 MM OD11.3 MM HIP CEMENT CONDYLAR STABILIZE|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|5428.00||||5428.00|4885.2|4885.2|1139.88
100023|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 127 D 8 46 MM OFFSET L135 MM OD11.3 MM HIP CEMENT CONDYLAR STABILIZE|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|5428.00||||5428.00|||
100023|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 127 D 8 46 MM OFFSET L135 MM OD11.3 MM HIP CEMENT CONDYLAR STABILIZE|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|5428.00||||5428.00|||
100023|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 127 D 8 46 MM OFFSET L135 MM OD11.3 MM HIP CEMENT CONDYLAR STABILIZE|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|5428.00||||5428.00|||
100023|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 127 D 8 46 MM OFFSET L135 MM OD11.3 MM HIP CEMENT CONDYLAR STABILIZE|CHAMPVA [1240]|CHAMP VA [124000]|5428.00||||5428.00|||
100023|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 127 D 8 46 MM OFFSET L135 MM OD11.3 MM HIP CEMENT CONDYLAR STABILIZE|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|5428.00||||5428.00|||
100023|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 127 D 8 46 MM OFFSET L135 MM OD11.3 MM HIP CEMENT CONDYLAR STABILIZE|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|5428.00||||5428.00|||
100023|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 127 D 8 46 MM OFFSET L135 MM OD11.3 MM HIP CEMENT CONDYLAR STABILIZE|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|5428.00||||5428.00|||
100023|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 127 D 8 46 MM OFFSET L135 MM OD11.3 MM HIP CEMENT CONDYLAR STABILIZE|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|5428.00||||5428.00|||
100023|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 127 D 8 46 MM OFFSET L135 MM OD11.3 MM HIP CEMENT CONDYLAR STABILIZE|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|5428.00||||5428.00|||
100023|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 127 D 8 46 MM OFFSET L135 MM OD11.3 MM HIP CEMENT CONDYLAR STABILIZE|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|5428.00||||5428.00|||
100023|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 127 D 8 46 MM OFFSET L135 MM OD11.3 MM HIP CEMENT CONDYLAR STABILIZE|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|5428.00||||5428.00|||
100023|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 127 D 8 46 MM OFFSET L135 MM OD11.3 MM HIP CEMENT CONDYLAR STABILIZE|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|5428.00||||5428.00|||
100023|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 127 D 8 46 MM OFFSET L135 MM OD11.3 MM HIP CEMENT CONDYLAR STABILIZE|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|5428.00||||5428.00|||
100023|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 127 D 8 46 MM OFFSET L135 MM OD11.3 MM HIP CEMENT CONDYLAR STABILIZE|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|5428.00||||5428.00|||
100023|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 127 D 8 46 MM OFFSET L135 MM OD11.3 MM HIP CEMENT CONDYLAR STABILIZE|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|5428.00||||5428.00|||
100023|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 127 D 8 46 MM OFFSET L135 MM OD11.3 MM HIP CEMENT CONDYLAR STABILIZE|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|5428.00||||5428.00|||
100023|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 127 D 8 46 MM OFFSET L135 MM OD11.3 MM HIP CEMENT CONDYLAR STABILIZE|UNITED HEALTHCARE [2060]|UHC MEDICA CHOICE [206030]|5428.00||||5428.00|||
100023|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 127 D 8 46 MM OFFSET L135 MM OD11.3 MM HIP CEMENT CONDYLAR STABILIZE|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|5428.00||||5428.00|||
100023|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 127 D 8 46 MM OFFSET L135 MM OD11.3 MM HIP CEMENT CONDYLAR STABILIZE|GEHA [1415]|GEHA - ASA [141503]|5428.00||||5428.00|||
100023|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 127 D 8 46 MM OFFSET L135 MM OD11.3 MM HIP CEMENT CONDYLAR STABILIZE|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|5428.00||||5428.00|||
100023|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 127 D 8 46 MM OFFSET L135 MM OD11.3 MM HIP CEMENT CONDYLAR STABILIZE|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|5428.00||||5428.00|||
100023|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 127 D 8 46 MM OFFSET L135 MM OD11.3 MM HIP CEMENT CONDYLAR STABILIZE|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|5428.00||||5428.00|||
100023|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 127 D 8 46 MM OFFSET L135 MM OD11.3 MM HIP CEMENT CONDYLAR STABILIZE|UMR [2035]|UMR OPTIONS [203501]|5428.00||||5428.00|||
100023|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 127 D 8 46 MM OFFSET L135 MM OD11.3 MM HIP CEMENT CONDYLAR STABILIZE|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|5428.00||||5428.00|||
100023|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 127 D 8 46 MM OFFSET L135 MM OD11.3 MM HIP CEMENT CONDYLAR STABILIZE|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|5428.00||||5428.00|||
100027|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 132 D 4 29 MM OFFSET L100 MM OD8.1 MM HIP CEMENT CONDYLAR STABILIZE STERILE|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|5428.00||||5428.00|4885.2|4885.2|1139.88
100027|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 132 D 4 29 MM OFFSET L100 MM OD8.1 MM HIP CEMENT CONDYLAR STABILIZE STERILE|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|5428.00||||5428.00|2714|4885.2|1139.88
100027|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 132 D 4 29 MM OFFSET L100 MM OD8.1 MM HIP CEMENT CONDYLAR STABILIZE STERILE|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|5428.00||||5428.00|1791.24|4885.2|1139.88
100027|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 132 D 4 29 MM OFFSET L100 MM OD8.1 MM HIP CEMENT CONDYLAR STABILIZE STERILE|FMH BENEFIT SERVICES [1390]|FMH [139000]|5428.00||||5428.00|4885.2|4885.2|1139.88
100027|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 132 D 4 29 MM OFFSET L100 MM OD8.1 MM HIP CEMENT CONDYLAR STABILIZE STERILE|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|5428.00||||5428.00|4885.2|4885.2|1139.88
100027|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 132 D 4 29 MM OFFSET L100 MM OD8.1 MM HIP CEMENT CONDYLAR STABILIZE STERILE|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|5428.00||||5428.00|4885.2|4885.2|1139.88
100027|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 132 D 4 29 MM OFFSET L100 MM OD8.1 MM HIP CEMENT CONDYLAR STABILIZE STERILE|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|5428.00||||5428.00|4885.2|4885.2|1139.88
100027|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 132 D 4 29 MM OFFSET L100 MM OD8.1 MM HIP CEMENT CONDYLAR STABILIZE STERILE|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|5428.00||||5428.00|3142.81|4885.2|1139.88
100027|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 132 D 4 29 MM OFFSET L100 MM OD8.1 MM HIP CEMENT CONDYLAR STABILIZE STERILE|CIGNA [1260]|CIGNA - GREAT WEST [126009]|5428.00||||5428.00|3799.6|4885.2|1139.88
100027|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 132 D 4 29 MM OFFSET L100 MM OD8.1 MM HIP CEMENT CONDYLAR STABILIZE STERILE|HEALTHNET [1495]|HEALTHNET [149500]|5428.00||||5428.00|4885.2|4885.2|1139.88
100027|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 132 D 4 29 MM OFFSET L100 MM OD8.1 MM HIP CEMENT CONDYLAR STABILIZE STERILE|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|5428.00||||5428.00|1731.53|4885.2|1139.88
100027|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 132 D 4 29 MM OFFSET L100 MM OD8.1 MM HIP CEMENT CONDYLAR STABILIZE STERILE|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|5428.00||||5428.00|2334.04|4885.2|1139.88
100027|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 132 D 4 29 MM OFFSET L100 MM OD8.1 MM HIP CEMENT CONDYLAR STABILIZE STERILE|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|5428.00||||5428.00|1899.8|4885.2|1139.88
100027|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 132 D 4 29 MM OFFSET L100 MM OD8.1 MM HIP CEMENT CONDYLAR STABILIZE STERILE|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|5428.00||||5428.00|4885.2|4885.2|1139.88
100027|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 132 D 4 29 MM OFFSET L100 MM OD8.1 MM HIP CEMENT CONDYLAR STABILIZE STERILE|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|5428.00||||5428.00|2714|4885.2|1139.88
100027|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 132 D 4 29 MM OFFSET L100 MM OD8.1 MM HIP CEMENT CONDYLAR STABILIZE STERILE|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|5428.00||||5428.00|4885.2|4885.2|1139.88
100027|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 132 D 4 29 MM OFFSET L100 MM OD8.1 MM HIP CEMENT CONDYLAR STABILIZE STERILE|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|5428.00||||5428.00|3528.2|4885.2|1139.88
100027|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 132 D 4 29 MM OFFSET L100 MM OD8.1 MM HIP CEMENT CONDYLAR STABILIZE STERILE|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|5428.00||||5428.00|4179.56|4885.2|1139.88
100027|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 132 D 4 29 MM OFFSET L100 MM OD8.1 MM HIP CEMENT CONDYLAR STABILIZE STERILE|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|5428.00||||5428.00|4885.2|4885.2|1139.88
100027|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 132 D 4 29 MM OFFSET L100 MM OD8.1 MM HIP CEMENT CONDYLAR STABILIZE STERILE|FIRST HEALTH [1375]|BENVEO/UCS [137512]|5428.00||||5428.00|4613.8|4885.2|1139.88
100027|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 132 D 4 29 MM OFFSET L100 MM OD8.1 MM HIP CEMENT CONDYLAR STABILIZE STERILE|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|5428.00||||5428.00|4885.2|4885.2|1139.88
100027|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 132 D 4 29 MM OFFSET L100 MM OD8.1 MM HIP CEMENT CONDYLAR STABILIZE STERILE|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|5428.00||||5428.00|1139.88|4885.2|1139.88
100027|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 132 D 4 29 MM OFFSET L100 MM OD8.1 MM HIP CEMENT CONDYLAR STABILIZE STERILE|FIRST HEALTH [1375]|QUALCHOICE [137513]|5428.00||||5428.00|4885.2|4885.2|1139.88
100027|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 132 D 4 29 MM OFFSET L100 MM OD8.1 MM HIP CEMENT CONDYLAR STABILIZE STERILE|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|5428.00||||5428.00|1899.8|4885.2|1139.88
100027|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 132 D 4 29 MM OFFSET L100 MM OD8.1 MM HIP CEMENT CONDYLAR STABILIZE STERILE|AETNA [1015]|AETNA ACO WILCO [101532]|5428.00||||5428.00|1899.8|4885.2|1139.88
100027|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 132 D 4 29 MM OFFSET L100 MM OD8.1 MM HIP CEMENT CONDYLAR STABILIZE STERILE|GROUP PENSION ADMIN [1450]|GPA [145000]|5428.00||||5428.00|3799.6|4885.2|1139.88
100027|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 132 D 4 29 MM OFFSET L100 MM OD8.1 MM HIP CEMENT CONDYLAR STABILIZE STERILE|CORESOURCE [1315]|CORESOURCE [131500]|5428.00||||5428.00|4885.2|4885.2|1139.88
100027|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 132 D 4 29 MM OFFSET L100 MM OD8.1 MM HIP CEMENT CONDYLAR STABILIZE STERILE|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|5428.00||||5428.00|2198.34|4885.2|1139.88
100027|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 132 D 4 29 MM OFFSET L100 MM OD8.1 MM HIP CEMENT CONDYLAR STABILIZE STERILE|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|5428.00||||5428.00|3528.2|4885.2|1139.88
100027|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 132 D 4 29 MM OFFSET L100 MM OD8.1 MM HIP CEMENT CONDYLAR STABILIZE STERILE|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|5428.00||||5428.00|2334.04|4885.2|1139.88
100027|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 132 D 4 29 MM OFFSET L100 MM OD8.1 MM HIP CEMENT CONDYLAR STABILIZE STERILE|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|5428.00||||5428.00|4885.2|4885.2|1139.88
100027|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 132 D 4 29 MM OFFSET L100 MM OD8.1 MM HIP CEMENT CONDYLAR STABILIZE STERILE|AETNA [1015]|COVENTRY HEALTHCARE [101502]|5428.00||||5428.00|4885.2|4885.2|1139.88
100027|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 132 D 4 29 MM OFFSET L100 MM OD8.1 MM HIP CEMENT CONDYLAR STABILIZE STERILE|<Self-pay>|<Self-pay>|5428.00||||5428.00|1628.4|4885.2|1139.88
100027|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 132 D 4 29 MM OFFSET L100 MM OD8.1 MM HIP CEMENT CONDYLAR STABILIZE STERILE|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|5428.00||||5428.00|4885.2|4885.2|1139.88
100027|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 132 D 4 29 MM OFFSET L100 MM OD8.1 MM HIP CEMENT CONDYLAR STABILIZE STERILE|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|5428.00||||5428.00|4885.2|4885.2|1139.88
100027|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 132 D 4 29 MM OFFSET L100 MM OD8.1 MM HIP CEMENT CONDYLAR STABILIZE STERILE|MULTIPLAN [1680]|HMA [168003]|5428.00||||5428.00|1899.8|4885.2|1139.88
100027|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 132 D 4 29 MM OFFSET L100 MM OD8.1 MM HIP CEMENT CONDYLAR STABILIZE STERILE|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|5428.00||||5428.00|4885.2|4885.2|1139.88
100027|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 132 D 4 29 MM OFFSET L100 MM OD8.1 MM HIP CEMENT CONDYLAR STABILIZE STERILE|SAMBA HEALTH [2305]|SAMBA HEALTH [230500]|5428.00||||5428.00|3799.6|4885.2|1139.88
100027|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 132 D 4 29 MM OFFSET L100 MM OD8.1 MM HIP CEMENT CONDYLAR STABILIZE STERILE|TRUSTMARK [2030]|STARMARK [203000]|5428.00||||5428.00|4885.2|4885.2|1139.88
100027|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 132 D 4 29 MM OFFSET L100 MM OD8.1 MM HIP CEMENT CONDYLAR STABILIZE STERILE|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|5428.00||||5428.00|4885.2|4885.2|1139.88
100027|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 132 D 4 29 MM OFFSET L100 MM OD8.1 MM HIP CEMENT CONDYLAR STABILIZE STERILE|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|5428.00||||5428.00|4885.2|4885.2|1139.88
100027|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 132 D 4 29 MM OFFSET L100 MM OD8.1 MM HIP CEMENT CONDYLAR STABILIZE STERILE|MULTIPLAN [1680]|IHC HS [168011]|5428.00||||5428.00|4885.2|4885.2|1139.88
100027|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 132 D 4 29 MM OFFSET L100 MM OD8.1 MM HIP CEMENT CONDYLAR STABILIZE STERILE|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|5428.00||||5428.00|2670.58|4885.2|1139.88
100027|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 132 D 4 29 MM OFFSET L100 MM OD8.1 MM HIP CEMENT CONDYLAR STABILIZE STERILE|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|5428.00||||5428.00|3528.2|4885.2|1139.88
100027|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 132 D 4 29 MM OFFSET L100 MM OD8.1 MM HIP CEMENT CONDYLAR STABILIZE STERILE|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|5428.00||||5428.00|4885.2|4885.2|1139.88
100027|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 132 D 4 29 MM OFFSET L100 MM OD8.1 MM HIP CEMENT CONDYLAR STABILIZE STERILE|AETNA [1015]|AMERICAN CONTINENTAL [101507]|5428.00||||5428.00|3799.6|4885.2|1139.88
100027|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 132 D 4 29 MM OFFSET L100 MM OD8.1 MM HIP CEMENT CONDYLAR STABILIZE STERILE|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|5428.00||||5428.00|||
100027|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 132 D 4 29 MM OFFSET L100 MM OD8.1 MM HIP CEMENT CONDYLAR STABILIZE STERILE|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|5428.00||||5428.00|||
100027|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 132 D 4 29 MM OFFSET L100 MM OD8.1 MM HIP CEMENT CONDYLAR STABILIZE STERILE|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|5428.00||||5428.00|||
100027|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 132 D 4 29 MM OFFSET L100 MM OD8.1 MM HIP CEMENT CONDYLAR STABILIZE STERILE|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|5428.00||||5428.00|||
100027|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 132 D 4 29 MM OFFSET L100 MM OD8.1 MM HIP CEMENT CONDYLAR STABILIZE STERILE|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|5428.00||||5428.00|||
100027|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 132 D 4 29 MM OFFSET L100 MM OD8.1 MM HIP CEMENT CONDYLAR STABILIZE STERILE|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|5428.00||||5428.00|||
100027|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 132 D 4 29 MM OFFSET L100 MM OD8.1 MM HIP CEMENT CONDYLAR STABILIZE STERILE|CHAMPVA [1240]|CHAMP VA [124000]|5428.00||||5428.00|||
100027|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 132 D 4 29 MM OFFSET L100 MM OD8.1 MM HIP CEMENT CONDYLAR STABILIZE STERILE|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|5428.00||||5428.00|||
100027|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 132 D 4 29 MM OFFSET L100 MM OD8.1 MM HIP CEMENT CONDYLAR STABILIZE STERILE|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|5428.00||||5428.00|||
100027|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 132 D 4 29 MM OFFSET L100 MM OD8.1 MM HIP CEMENT CONDYLAR STABILIZE STERILE|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|5428.00||||5428.00|||
100027|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 132 D 4 29 MM OFFSET L100 MM OD8.1 MM HIP CEMENT CONDYLAR STABILIZE STERILE|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|5428.00||||5428.00|||
100027|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 132 D 4 29 MM OFFSET L100 MM OD8.1 MM HIP CEMENT CONDYLAR STABILIZE STERILE|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|5428.00||||5428.00|||
100027|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 132 D 4 29 MM OFFSET L100 MM OD8.1 MM HIP CEMENT CONDYLAR STABILIZE STERILE|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|5428.00||||5428.00|||
100027|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 132 D 4 29 MM OFFSET L100 MM OD8.1 MM HIP CEMENT CONDYLAR STABILIZE STERILE|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|5428.00||||5428.00|||
100027|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 132 D 4 29 MM OFFSET L100 MM OD8.1 MM HIP CEMENT CONDYLAR STABILIZE STERILE|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|5428.00||||5428.00|||
100027|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 132 D 4 29 MM OFFSET L100 MM OD8.1 MM HIP CEMENT CONDYLAR STABILIZE STERILE|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|5428.00||||5428.00|||
100027|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 132 D 4 29 MM OFFSET L100 MM OD8.1 MM HIP CEMENT CONDYLAR STABILIZE STERILE|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|5428.00||||5428.00|||
100027|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 132 D 4 29 MM OFFSET L100 MM OD8.1 MM HIP CEMENT CONDYLAR STABILIZE STERILE|UMR [2035]|UMR OPTIONS [203501]|5428.00||||5428.00|||
100027|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 132 D 4 29 MM OFFSET L100 MM OD8.1 MM HIP CEMENT CONDYLAR STABILIZE STERILE|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|5428.00||||5428.00|||
100027|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 132 D 4 29 MM OFFSET L100 MM OD8.1 MM HIP CEMENT CONDYLAR STABILIZE STERILE|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|5428.00||||5428.00|||
100027|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 132 D 4 29 MM OFFSET L100 MM OD8.1 MM HIP CEMENT CONDYLAR STABILIZE STERILE|GEHA [1415]|GEHA - ASA [141503]|5428.00||||5428.00|||
100027|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 132 D 4 29 MM OFFSET L100 MM OD8.1 MM HIP CEMENT CONDYLAR STABILIZE STERILE|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|5428.00||||5428.00|||
100027|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 132 D 4 29 MM OFFSET L100 MM OD8.1 MM HIP CEMENT CONDYLAR STABILIZE STERILE|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|5428.00||||5428.00|||
100027|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 132 D 4 29 MM OFFSET L100 MM OD8.1 MM HIP CEMENT CONDYLAR STABILIZE STERILE|UNITED HEALTHCARE [2060]|UHC MEDICA CHOICE [206030]|5428.00||||5428.00|||
100027|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 132 D 4 29 MM OFFSET L100 MM OD8.1 MM HIP CEMENT CONDYLAR STABILIZE STERILE|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|5428.00||||5428.00|||
100030|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 132 D 7 35 MM OFFSET L130 MM OD10.4 MM HIP CEMENT CONDYLAR STABILIZE STERILE|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|5428.00||||5428.00|3142.81|4885.2|1139.88
100030|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 132 D 7 35 MM OFFSET L130 MM OD10.4 MM HIP CEMENT CONDYLAR STABILIZE STERILE|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|5428.00||||5428.00|4885.2|4885.2|1139.88
100030|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 132 D 7 35 MM OFFSET L130 MM OD10.4 MM HIP CEMENT CONDYLAR STABILIZE STERILE|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|5428.00||||5428.00|4885.2|4885.2|1139.88
100030|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 132 D 7 35 MM OFFSET L130 MM OD10.4 MM HIP CEMENT CONDYLAR STABILIZE STERILE|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|5428.00||||5428.00|2198.34|4885.2|1139.88
100030|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 132 D 7 35 MM OFFSET L130 MM OD10.4 MM HIP CEMENT CONDYLAR STABILIZE STERILE|AETNA [1015]|AETNA ACO WILCO [101532]|5428.00||||5428.00|1899.8|4885.2|1139.88
100030|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 132 D 7 35 MM OFFSET L130 MM OD10.4 MM HIP CEMENT CONDYLAR STABILIZE STERILE|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|5428.00||||5428.00|3528.2|4885.2|1139.88
100030|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 132 D 7 35 MM OFFSET L130 MM OD10.4 MM HIP CEMENT CONDYLAR STABILIZE STERILE|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|5428.00||||5428.00|4885.2|4885.2|1139.88
100030|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 132 D 7 35 MM OFFSET L130 MM OD10.4 MM HIP CEMENT CONDYLAR STABILIZE STERILE|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|5428.00||||5428.00|3528.2|4885.2|1139.88
100030|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 132 D 7 35 MM OFFSET L130 MM OD10.4 MM HIP CEMENT CONDYLAR STABILIZE STERILE|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|5428.00||||5428.00|4885.2|4885.2|1139.88
100030|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 132 D 7 35 MM OFFSET L130 MM OD10.4 MM HIP CEMENT CONDYLAR STABILIZE STERILE|AETNA [1015]|COVENTRY HEALTHCARE [101502]|5428.00||||5428.00|4885.2|4885.2|1139.88
100030|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 132 D 7 35 MM OFFSET L130 MM OD10.4 MM HIP CEMENT CONDYLAR STABILIZE STERILE|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|5428.00||||5428.00|4885.2|4885.2|1139.88
100030|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 132 D 7 35 MM OFFSET L130 MM OD10.4 MM HIP CEMENT CONDYLAR STABILIZE STERILE|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|5428.00||||5428.00|4885.2|4885.2|1139.88
100030|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 132 D 7 35 MM OFFSET L130 MM OD10.4 MM HIP CEMENT CONDYLAR STABILIZE STERILE|FIRST HEALTH [1375]|QUALCHOICE [137513]|5428.00||||5428.00|4885.2|4885.2|1139.88
100030|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 132 D 7 35 MM OFFSET L130 MM OD10.4 MM HIP CEMENT CONDYLAR STABILIZE STERILE|GROUP PENSION ADMIN [1450]|GPA [145000]|5428.00||||5428.00|3799.6|4885.2|1139.88
100030|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 132 D 7 35 MM OFFSET L130 MM OD10.4 MM HIP CEMENT CONDYLAR STABILIZE STERILE|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|5428.00||||5428.00|4885.2|4885.2|1139.88
100030|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 132 D 7 35 MM OFFSET L130 MM OD10.4 MM HIP CEMENT CONDYLAR STABILIZE STERILE|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|5428.00||||5428.00|4885.2|4885.2|1139.88
100030|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 132 D 7 35 MM OFFSET L130 MM OD10.4 MM HIP CEMENT CONDYLAR STABILIZE STERILE|TRUSTMARK [2030]|STARMARK [203000]|5428.00||||5428.00|4885.2|4885.2|1139.88
100030|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 132 D 7 35 MM OFFSET L130 MM OD10.4 MM HIP CEMENT CONDYLAR STABILIZE STERILE|FIRST HEALTH [1375]|BENVEO/UCS [137512]|5428.00||||5428.00|4613.8|4885.2|1139.88
100030|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 132 D 7 35 MM OFFSET L130 MM OD10.4 MM HIP CEMENT CONDYLAR STABILIZE STERILE|<Self-pay>|<Self-pay>|5428.00||||5428.00|1628.4|4885.2|1139.88
100030|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 132 D 7 35 MM OFFSET L130 MM OD10.4 MM HIP CEMENT CONDYLAR STABILIZE STERILE|SAMBA HEALTH [2305]|SAMBA HEALTH [230500]|5428.00||||5428.00|3799.6|4885.2|1139.88
100030|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 132 D 7 35 MM OFFSET L130 MM OD10.4 MM HIP CEMENT CONDYLAR STABILIZE STERILE|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|5428.00||||5428.00|2334.04|4885.2|1139.88
100030|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 132 D 7 35 MM OFFSET L130 MM OD10.4 MM HIP CEMENT CONDYLAR STABILIZE STERILE|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|5428.00||||5428.00|2670.58|4885.2|1139.88
100030|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 132 D 7 35 MM OFFSET L130 MM OD10.4 MM HIP CEMENT CONDYLAR STABILIZE STERILE|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|5428.00||||5428.00|4885.2|4885.2|1139.88
100030|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 132 D 7 35 MM OFFSET L130 MM OD10.4 MM HIP CEMENT CONDYLAR STABILIZE STERILE|CORESOURCE [1315]|CORESOURCE [131500]|5428.00||||5428.00|4885.2|4885.2|1139.88
100030|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 132 D 7 35 MM OFFSET L130 MM OD10.4 MM HIP CEMENT CONDYLAR STABILIZE STERILE|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|5428.00||||5428.00|4885.2|4885.2|1139.88
100030|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 132 D 7 35 MM OFFSET L130 MM OD10.4 MM HIP CEMENT CONDYLAR STABILIZE STERILE|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|5428.00||||5428.00|3528.2|4885.2|1139.88
100030|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 132 D 7 35 MM OFFSET L130 MM OD10.4 MM HIP CEMENT CONDYLAR STABILIZE STERILE|AETNA [1015]|AMERICAN CONTINENTAL [101507]|5428.00||||5428.00|3799.6|4885.2|1139.88
100030|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 132 D 7 35 MM OFFSET L130 MM OD10.4 MM HIP CEMENT CONDYLAR STABILIZE STERILE|MULTIPLAN [1680]|HMA [168003]|5428.00||||5428.00|1899.8|4885.2|1139.88
100030|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 132 D 7 35 MM OFFSET L130 MM OD10.4 MM HIP CEMENT CONDYLAR STABILIZE STERILE|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|5428.00||||5428.00|4885.2|4885.2|1139.88
100030|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 132 D 7 35 MM OFFSET L130 MM OD10.4 MM HIP CEMENT CONDYLAR STABILIZE STERILE|MULTIPLAN [1680]|IHC HS [168011]|5428.00||||5428.00|4885.2|4885.2|1139.88
100030|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 132 D 7 35 MM OFFSET L130 MM OD10.4 MM HIP CEMENT CONDYLAR STABILIZE STERILE|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|5428.00||||5428.00|1899.8|4885.2|1139.88
100030|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 132 D 7 35 MM OFFSET L130 MM OD10.4 MM HIP CEMENT CONDYLAR STABILIZE STERILE|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|5428.00||||5428.00|2714|4885.2|1139.88
100030|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 132 D 7 35 MM OFFSET L130 MM OD10.4 MM HIP CEMENT CONDYLAR STABILIZE STERILE|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|5428.00||||5428.00|1139.88|4885.2|1139.88
100030|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 132 D 7 35 MM OFFSET L130 MM OD10.4 MM HIP CEMENT CONDYLAR STABILIZE STERILE|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|5428.00||||5428.00|1791.24|4885.2|1139.88
100030|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 132 D 7 35 MM OFFSET L130 MM OD10.4 MM HIP CEMENT CONDYLAR STABILIZE STERILE|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|5428.00||||5428.00|4885.2|4885.2|1139.88
100030|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 132 D 7 35 MM OFFSET L130 MM OD10.4 MM HIP CEMENT CONDYLAR STABILIZE STERILE|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|5428.00||||5428.00|4885.2|4885.2|1139.88
100030|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 132 D 7 35 MM OFFSET L130 MM OD10.4 MM HIP CEMENT CONDYLAR STABILIZE STERILE|CIGNA [1260]|CIGNA - GREAT WEST [126009]|5428.00||||5428.00|3799.6|4885.2|1139.88
100030|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 132 D 7 35 MM OFFSET L130 MM OD10.4 MM HIP CEMENT CONDYLAR STABILIZE STERILE|HEALTHNET [1495]|HEALTHNET [149500]|5428.00||||5428.00|4885.2|4885.2|1139.88
100030|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 132 D 7 35 MM OFFSET L130 MM OD10.4 MM HIP CEMENT CONDYLAR STABILIZE STERILE|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|5428.00||||5428.00|2334.04|4885.2|1139.88
100030|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 132 D 7 35 MM OFFSET L130 MM OD10.4 MM HIP CEMENT CONDYLAR STABILIZE STERILE|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|5428.00||||5428.00|4885.2|4885.2|1139.88
100030|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 132 D 7 35 MM OFFSET L130 MM OD10.4 MM HIP CEMENT CONDYLAR STABILIZE STERILE|FMH BENEFIT SERVICES [1390]|FMH [139000]|5428.00||||5428.00|4885.2|4885.2|1139.88
100030|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 132 D 7 35 MM OFFSET L130 MM OD10.4 MM HIP CEMENT CONDYLAR STABILIZE STERILE|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|5428.00||||5428.00|2714|4885.2|1139.88
100030|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 132 D 7 35 MM OFFSET L130 MM OD10.4 MM HIP CEMENT CONDYLAR STABILIZE STERILE|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|5428.00||||5428.00|4885.2|4885.2|1139.88
100030|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 132 D 7 35 MM OFFSET L130 MM OD10.4 MM HIP CEMENT CONDYLAR STABILIZE STERILE|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|5428.00||||5428.00|1731.53|4885.2|1139.88
100030|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 132 D 7 35 MM OFFSET L130 MM OD10.4 MM HIP CEMENT CONDYLAR STABILIZE STERILE|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|5428.00||||5428.00|1899.8|4885.2|1139.88
100030|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 132 D 7 35 MM OFFSET L130 MM OD10.4 MM HIP CEMENT CONDYLAR STABILIZE STERILE|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|5428.00||||5428.00|4179.56|4885.2|1139.88
100030|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 132 D 7 35 MM OFFSET L130 MM OD10.4 MM HIP CEMENT CONDYLAR STABILIZE STERILE|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|5428.00||||5428.00|||
100030|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 132 D 7 35 MM OFFSET L130 MM OD10.4 MM HIP CEMENT CONDYLAR STABILIZE STERILE|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|5428.00||||5428.00|||
100030|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 132 D 7 35 MM OFFSET L130 MM OD10.4 MM HIP CEMENT CONDYLAR STABILIZE STERILE|UMR [2035]|UMR OPTIONS [203501]|5428.00||||5428.00|||
100030|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 132 D 7 35 MM OFFSET L130 MM OD10.4 MM HIP CEMENT CONDYLAR STABILIZE STERILE|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|5428.00||||5428.00|||
100030|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 132 D 7 35 MM OFFSET L130 MM OD10.4 MM HIP CEMENT CONDYLAR STABILIZE STERILE|GEHA [1415]|GEHA - ASA [141503]|5428.00||||5428.00|||
100030|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 132 D 7 35 MM OFFSET L130 MM OD10.4 MM HIP CEMENT CONDYLAR STABILIZE STERILE|UNITED HEALTHCARE [2060]|UHC MEDICA CHOICE [206030]|5428.00||||5428.00|||
100030|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 132 D 7 35 MM OFFSET L130 MM OD10.4 MM HIP CEMENT CONDYLAR STABILIZE STERILE|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|5428.00||||5428.00|||
100030|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 132 D 7 35 MM OFFSET L130 MM OD10.4 MM HIP CEMENT CONDYLAR STABILIZE STERILE|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|5428.00||||5428.00|||
100030|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 132 D 7 35 MM OFFSET L130 MM OD10.4 MM HIP CEMENT CONDYLAR STABILIZE STERILE|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|5428.00||||5428.00|||
100030|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 132 D 7 35 MM OFFSET L130 MM OD10.4 MM HIP CEMENT CONDYLAR STABILIZE STERILE|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|5428.00||||5428.00|||
100030|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 132 D 7 35 MM OFFSET L130 MM OD10.4 MM HIP CEMENT CONDYLAR STABILIZE STERILE|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|5428.00||||5428.00|||
100030|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 132 D 7 35 MM OFFSET L130 MM OD10.4 MM HIP CEMENT CONDYLAR STABILIZE STERILE|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|5428.00||||5428.00|||
100030|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 132 D 7 35 MM OFFSET L130 MM OD10.4 MM HIP CEMENT CONDYLAR STABILIZE STERILE|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|5428.00||||5428.00|||
100030|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 132 D 7 35 MM OFFSET L130 MM OD10.4 MM HIP CEMENT CONDYLAR STABILIZE STERILE|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|5428.00||||5428.00|||
100030|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 132 D 7 35 MM OFFSET L130 MM OD10.4 MM HIP CEMENT CONDYLAR STABILIZE STERILE|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|5428.00||||5428.00|||
100030|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 132 D 7 35 MM OFFSET L130 MM OD10.4 MM HIP CEMENT CONDYLAR STABILIZE STERILE|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|5428.00||||5428.00|||
100030|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 132 D 7 35 MM OFFSET L130 MM OD10.4 MM HIP CEMENT CONDYLAR STABILIZE STERILE|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|5428.00||||5428.00|||
100030|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 132 D 7 35 MM OFFSET L130 MM OD10.4 MM HIP CEMENT CONDYLAR STABILIZE STERILE|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|5428.00||||5428.00|||
100030|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 132 D 7 35 MM OFFSET L130 MM OD10.4 MM HIP CEMENT CONDYLAR STABILIZE STERILE|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|5428.00||||5428.00|||
100030|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 132 D 7 35 MM OFFSET L130 MM OD10.4 MM HIP CEMENT CONDYLAR STABILIZE STERILE|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|5428.00||||5428.00|||
100030|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 132 D 7 35 MM OFFSET L130 MM OD10.4 MM HIP CEMENT CONDYLAR STABILIZE STERILE|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|5428.00||||5428.00|||
100030|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 132 D 7 35 MM OFFSET L130 MM OD10.4 MM HIP CEMENT CONDYLAR STABILIZE STERILE|CHAMPVA [1240]|CHAMP VA [124000]|5428.00||||5428.00|||
100030|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 132 D 7 35 MM OFFSET L130 MM OD10.4 MM HIP CEMENT CONDYLAR STABILIZE STERILE|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|5428.00||||5428.00|||
100030|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 132 D 7 35 MM OFFSET L130 MM OD10.4 MM HIP CEMENT CONDYLAR STABILIZE STERILE|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|5428.00||||5428.00|||
100030|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 132 D 7 35 MM OFFSET L130 MM OD10.4 MM HIP CEMENT CONDYLAR STABILIZE STERILE|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|5428.00||||5428.00|||
100031|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 132 D 8 42 MM OFFSET L135 MM OD11.3 MM HIP CEMENT CONDYLAR STABILIZE STERILE|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|5428.00||||5428.00|1139.88|4885.2|1139.88
100031|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 132 D 8 42 MM OFFSET L135 MM OD11.3 MM HIP CEMENT CONDYLAR STABILIZE STERILE|FMH BENEFIT SERVICES [1390]|FMH [139000]|5428.00||||5428.00|4885.2|4885.2|1139.88
100031|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 132 D 8 42 MM OFFSET L135 MM OD11.3 MM HIP CEMENT CONDYLAR STABILIZE STERILE|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|5428.00||||5428.00|2334.04|4885.2|1139.88
100031|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 132 D 8 42 MM OFFSET L135 MM OD11.3 MM HIP CEMENT CONDYLAR STABILIZE STERILE|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|5428.00||||5428.00|4179.56|4885.2|1139.88
100031|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 132 D 8 42 MM OFFSET L135 MM OD11.3 MM HIP CEMENT CONDYLAR STABILIZE STERILE|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|5428.00||||5428.00|1899.8|4885.2|1139.88
100031|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 132 D 8 42 MM OFFSET L135 MM OD11.3 MM HIP CEMENT CONDYLAR STABILIZE STERILE|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|5428.00||||5428.00|4885.2|4885.2|1139.88
100031|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 132 D 8 42 MM OFFSET L135 MM OD11.3 MM HIP CEMENT CONDYLAR STABILIZE STERILE|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|5428.00||||5428.00|1791.24|4885.2|1139.88
100031|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 132 D 8 42 MM OFFSET L135 MM OD11.3 MM HIP CEMENT CONDYLAR STABILIZE STERILE|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|5428.00||||5428.00|2714|4885.2|1139.88
100031|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 132 D 8 42 MM OFFSET L135 MM OD11.3 MM HIP CEMENT CONDYLAR STABILIZE STERILE|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|5428.00||||5428.00|1731.53|4885.2|1139.88
100031|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 132 D 8 42 MM OFFSET L135 MM OD11.3 MM HIP CEMENT CONDYLAR STABILIZE STERILE|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|5428.00||||5428.00|3528.2|4885.2|1139.88
100031|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 132 D 8 42 MM OFFSET L135 MM OD11.3 MM HIP CEMENT CONDYLAR STABILIZE STERILE|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|5428.00||||5428.00|4885.2|4885.2|1139.88
100031|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 132 D 8 42 MM OFFSET L135 MM OD11.3 MM HIP CEMENT CONDYLAR STABILIZE STERILE|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|5428.00||||5428.00|4885.2|4885.2|1139.88
100031|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 132 D 8 42 MM OFFSET L135 MM OD11.3 MM HIP CEMENT CONDYLAR STABILIZE STERILE|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|5428.00||||5428.00|2714|4885.2|1139.88
100031|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 132 D 8 42 MM OFFSET L135 MM OD11.3 MM HIP CEMENT CONDYLAR STABILIZE STERILE|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|5428.00||||5428.00|4885.2|4885.2|1139.88
100031|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 132 D 8 42 MM OFFSET L135 MM OD11.3 MM HIP CEMENT CONDYLAR STABILIZE STERILE|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|5428.00||||5428.00|4885.2|4885.2|1139.88
100031|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 132 D 8 42 MM OFFSET L135 MM OD11.3 MM HIP CEMENT CONDYLAR STABILIZE STERILE|HEALTHNET [1495]|HEALTHNET [149500]|5428.00||||5428.00|4885.2|4885.2|1139.88
100031|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 132 D 8 42 MM OFFSET L135 MM OD11.3 MM HIP CEMENT CONDYLAR STABILIZE STERILE|AETNA [1015]|COVENTRY HEALTHCARE [101502]|5428.00||||5428.00|4885.2|4885.2|1139.88
100031|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 132 D 8 42 MM OFFSET L135 MM OD11.3 MM HIP CEMENT CONDYLAR STABILIZE STERILE|AETNA [1015]|AMERICAN CONTINENTAL [101507]|5428.00||||5428.00|3799.6|4885.2|1139.88
100031|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 132 D 8 42 MM OFFSET L135 MM OD11.3 MM HIP CEMENT CONDYLAR STABILIZE STERILE|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|5428.00||||5428.00|4885.2|4885.2|1139.88
100031|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 132 D 8 42 MM OFFSET L135 MM OD11.3 MM HIP CEMENT CONDYLAR STABILIZE STERILE|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|5428.00||||5428.00|3528.2|4885.2|1139.88
100031|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 132 D 8 42 MM OFFSET L135 MM OD11.3 MM HIP CEMENT CONDYLAR STABILIZE STERILE|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|5428.00||||5428.00|1899.8|4885.2|1139.88
100031|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 132 D 8 42 MM OFFSET L135 MM OD11.3 MM HIP CEMENT CONDYLAR STABILIZE STERILE|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|5428.00||||5428.00|3142.81|4885.2|1139.88
100031|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 132 D 8 42 MM OFFSET L135 MM OD11.3 MM HIP CEMENT CONDYLAR STABILIZE STERILE|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|5428.00||||5428.00|4885.2|4885.2|1139.88
100031|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 132 D 8 42 MM OFFSET L135 MM OD11.3 MM HIP CEMENT CONDYLAR STABILIZE STERILE|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|5428.00||||5428.00|4885.2|4885.2|1139.88
100031|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 132 D 8 42 MM OFFSET L135 MM OD11.3 MM HIP CEMENT CONDYLAR STABILIZE STERILE|CIGNA [1260]|CIGNA - GREAT WEST [126009]|5428.00||||5428.00|3799.6|4885.2|1139.88
100031|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 132 D 8 42 MM OFFSET L135 MM OD11.3 MM HIP CEMENT CONDYLAR STABILIZE STERILE|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|5428.00||||5428.00|4885.2|4885.2|1139.88
100031|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 132 D 8 42 MM OFFSET L135 MM OD11.3 MM HIP CEMENT CONDYLAR STABILIZE STERILE|CORESOURCE [1315]|CORESOURCE [131500]|5428.00||||5428.00|4885.2|4885.2|1139.88
100031|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 132 D 8 42 MM OFFSET L135 MM OD11.3 MM HIP CEMENT CONDYLAR STABILIZE STERILE|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|5428.00||||5428.00|4885.2|4885.2|1139.88
100031|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 132 D 8 42 MM OFFSET L135 MM OD11.3 MM HIP CEMENT CONDYLAR STABILIZE STERILE|FIRST HEALTH [1375]|BENVEO/UCS [137512]|5428.00||||5428.00|4613.8|4885.2|1139.88
100031|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 132 D 8 42 MM OFFSET L135 MM OD11.3 MM HIP CEMENT CONDYLAR STABILIZE STERILE|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|5428.00||||5428.00|2334.04|4885.2|1139.88
100031|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 132 D 8 42 MM OFFSET L135 MM OD11.3 MM HIP CEMENT CONDYLAR STABILIZE STERILE|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|5428.00||||5428.00|2670.58|4885.2|1139.88
100031|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 132 D 8 42 MM OFFSET L135 MM OD11.3 MM HIP CEMENT CONDYLAR STABILIZE STERILE|FIRST HEALTH [1375]|QUALCHOICE [137513]|5428.00||||5428.00|4885.2|4885.2|1139.88
100031|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 132 D 8 42 MM OFFSET L135 MM OD11.3 MM HIP CEMENT CONDYLAR STABILIZE STERILE|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|5428.00||||5428.00|4885.2|4885.2|1139.88
100031|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 132 D 8 42 MM OFFSET L135 MM OD11.3 MM HIP CEMENT CONDYLAR STABILIZE STERILE|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|5428.00||||5428.00|3528.2|4885.2|1139.88
100031|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 132 D 8 42 MM OFFSET L135 MM OD11.3 MM HIP CEMENT CONDYLAR STABILIZE STERILE|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|5428.00||||5428.00|4885.2|4885.2|1139.88
100031|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 132 D 8 42 MM OFFSET L135 MM OD11.3 MM HIP CEMENT CONDYLAR STABILIZE STERILE|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|5428.00||||5428.00|4885.2|4885.2|1139.88
100031|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 132 D 8 42 MM OFFSET L135 MM OD11.3 MM HIP CEMENT CONDYLAR STABILIZE STERILE|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|5428.00||||5428.00|4885.2|4885.2|1139.88
100031|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 132 D 8 42 MM OFFSET L135 MM OD11.3 MM HIP CEMENT CONDYLAR STABILIZE STERILE|MULTIPLAN [1680]|HMA [168003]|5428.00||||5428.00|1899.8|4885.2|1139.88
100031|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 132 D 8 42 MM OFFSET L135 MM OD11.3 MM HIP CEMENT CONDYLAR STABILIZE STERILE|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|5428.00||||5428.00|4885.2|4885.2|1139.88
100031|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 132 D 8 42 MM OFFSET L135 MM OD11.3 MM HIP CEMENT CONDYLAR STABILIZE STERILE|MULTIPLAN [1680]|IHC HS [168011]|5428.00||||5428.00|4885.2|4885.2|1139.88
100031|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 132 D 8 42 MM OFFSET L135 MM OD11.3 MM HIP CEMENT CONDYLAR STABILIZE STERILE|TRUSTMARK [2030]|STARMARK [203000]|5428.00||||5428.00|4885.2|4885.2|1139.88
100031|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 132 D 8 42 MM OFFSET L135 MM OD11.3 MM HIP CEMENT CONDYLAR STABILIZE STERILE|SAMBA HEALTH [2305]|SAMBA HEALTH [230500]|5428.00||||5428.00|3799.6|4885.2|1139.88
100031|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 132 D 8 42 MM OFFSET L135 MM OD11.3 MM HIP CEMENT CONDYLAR STABILIZE STERILE|AETNA [1015]|AETNA ACO WILCO [101532]|5428.00||||5428.00|1899.8|4885.2|1139.88
100031|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 132 D 8 42 MM OFFSET L135 MM OD11.3 MM HIP CEMENT CONDYLAR STABILIZE STERILE|GROUP PENSION ADMIN [1450]|GPA [145000]|5428.00||||5428.00|3799.6|4885.2|1139.88
100031|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 132 D 8 42 MM OFFSET L135 MM OD11.3 MM HIP CEMENT CONDYLAR STABILIZE STERILE|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|5428.00||||5428.00|2198.34|4885.2|1139.88
100031|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 132 D 8 42 MM OFFSET L135 MM OD11.3 MM HIP CEMENT CONDYLAR STABILIZE STERILE|<Self-pay>|<Self-pay>|5428.00||||5428.00|1628.4|4885.2|1139.88
100031|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 132 D 8 42 MM OFFSET L135 MM OD11.3 MM HIP CEMENT CONDYLAR STABILIZE STERILE|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|5428.00||||5428.00|||
100031|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 132 D 8 42 MM OFFSET L135 MM OD11.3 MM HIP CEMENT CONDYLAR STABILIZE STERILE|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|5428.00||||5428.00|||
100031|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 132 D 8 42 MM OFFSET L135 MM OD11.3 MM HIP CEMENT CONDYLAR STABILIZE STERILE|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|5428.00||||5428.00|||
100031|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 132 D 8 42 MM OFFSET L135 MM OD11.3 MM HIP CEMENT CONDYLAR STABILIZE STERILE|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|5428.00||||5428.00|||
100031|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 132 D 8 42 MM OFFSET L135 MM OD11.3 MM HIP CEMENT CONDYLAR STABILIZE STERILE|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|5428.00||||5428.00|||
100031|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 132 D 8 42 MM OFFSET L135 MM OD11.3 MM HIP CEMENT CONDYLAR STABILIZE STERILE|CHAMPVA [1240]|CHAMP VA [124000]|5428.00||||5428.00|||
100031|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 132 D 8 42 MM OFFSET L135 MM OD11.3 MM HIP CEMENT CONDYLAR STABILIZE STERILE|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|5428.00||||5428.00|||
100031|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 132 D 8 42 MM OFFSET L135 MM OD11.3 MM HIP CEMENT CONDYLAR STABILIZE STERILE|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|5428.00||||5428.00|||
100031|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 132 D 8 42 MM OFFSET L135 MM OD11.3 MM HIP CEMENT CONDYLAR STABILIZE STERILE|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|5428.00||||5428.00|||
100031|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 132 D 8 42 MM OFFSET L135 MM OD11.3 MM HIP CEMENT CONDYLAR STABILIZE STERILE|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|5428.00||||5428.00|||
100031|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 132 D 8 42 MM OFFSET L135 MM OD11.3 MM HIP CEMENT CONDYLAR STABILIZE STERILE|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|5428.00||||5428.00|||
100031|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 132 D 8 42 MM OFFSET L135 MM OD11.3 MM HIP CEMENT CONDYLAR STABILIZE STERILE|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|5428.00||||5428.00|||
100031|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 132 D 8 42 MM OFFSET L135 MM OD11.3 MM HIP CEMENT CONDYLAR STABILIZE STERILE|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|5428.00||||5428.00|||
100031|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 132 D 8 42 MM OFFSET L135 MM OD11.3 MM HIP CEMENT CONDYLAR STABILIZE STERILE|GEHA [1415]|GEHA - ASA [141503]|5428.00||||5428.00|||
100031|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 132 D 8 42 MM OFFSET L135 MM OD11.3 MM HIP CEMENT CONDYLAR STABILIZE STERILE|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|5428.00||||5428.00|||
100031|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 132 D 8 42 MM OFFSET L135 MM OD11.3 MM HIP CEMENT CONDYLAR STABILIZE STERILE|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|5428.00||||5428.00|||
100031|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 132 D 8 42 MM OFFSET L135 MM OD11.3 MM HIP CEMENT CONDYLAR STABILIZE STERILE|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|5428.00||||5428.00|||
100031|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 132 D 8 42 MM OFFSET L135 MM OD11.3 MM HIP CEMENT CONDYLAR STABILIZE STERILE|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|5428.00||||5428.00|||
100031|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 132 D 8 42 MM OFFSET L135 MM OD11.3 MM HIP CEMENT CONDYLAR STABILIZE STERILE|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|5428.00||||5428.00|||
100031|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 132 D 8 42 MM OFFSET L135 MM OD11.3 MM HIP CEMENT CONDYLAR STABILIZE STERILE|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|5428.00||||5428.00|||
100031|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 132 D 8 42 MM OFFSET L135 MM OD11.3 MM HIP CEMENT CONDYLAR STABILIZE STERILE|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|5428.00||||5428.00|||
100031|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 132 D 8 42 MM OFFSET L135 MM OD11.3 MM HIP CEMENT CONDYLAR STABILIZE STERILE|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|5428.00||||5428.00|||
100031|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 132 D 8 42 MM OFFSET L135 MM OD11.3 MM HIP CEMENT CONDYLAR STABILIZE STERILE|UMR [2035]|UMR OPTIONS [203501]|5428.00||||5428.00|||
100031|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 132 D 8 42 MM OFFSET L135 MM OD11.3 MM HIP CEMENT CONDYLAR STABILIZE STERILE|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|5428.00||||5428.00|||
100031|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 132 D 8 42 MM OFFSET L135 MM OD11.3 MM HIP CEMENT CONDYLAR STABILIZE STERILE|UNITED HEALTHCARE [2060]|UHC MEDICA CHOICE [206030]|5428.00||||5428.00|||
100039|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L20 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|464.64||||464.64|232.32|418.18|97.57
100039|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L20 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|464.64||||464.64|232.32|418.18|97.57
100039|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L20 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|464.64||||464.64|199.8|418.18|97.57
100039|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L20 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|FMH BENEFIT SERVICES [1390]|FMH [139000]|464.64||||464.64|418.18|418.18|97.57
100039|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L20 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|464.64||||464.64|97.57|418.18|97.57
100039|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L20 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|464.64||||464.64|418.18|418.18|97.57
100039|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L20 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|464.64||||464.64|153.33|418.18|97.57
100039|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L20 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|464.64||||464.64|357.77|418.18|97.57
100039|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L20 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|464.64||||464.64|418.18|418.18|97.57
100039|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L20 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|464.64||||464.64|418.18|418.18|97.57
100039|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L20 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|TRUSTMARK [2030]|STARMARK [203000]|464.64||||464.64|418.18|418.18|97.57
100039|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L20 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|464.64||||464.64|418.18|418.18|97.57
100039|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L20 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|FIRST HEALTH [1375]|QUALCHOICE [137513]|464.64||||464.64|418.18|418.18|97.57
100039|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L20 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|<Self-pay>|<Self-pay>|464.64||||464.64|139.39|418.18|97.57
100039|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L20 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|464.64||||464.64|302.02|418.18|97.57
100039|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L20 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|464.64||||464.64|418.18|418.18|97.57
100039|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L20 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|MULTIPLAN [1680]|IHC HS [168011]|464.64||||464.64|418.18|418.18|97.57
100039|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L20 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|464.64||||464.64|199.8|418.18|97.57
100039|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L20 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|464.64||||464.64|418.18|418.18|97.57
100039|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L20 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|464.64||||464.64|228.6|418.18|97.57
100039|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L20 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|AETNA [1015]|AMERICAN CONTINENTAL [101507]|464.64||||464.64|325.25|418.18|97.57
100039|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L20 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|464.64||||464.64|269.03|418.18|97.57
100039|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L20 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|464.64||||464.64|418.18|418.18|97.57
100039|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L20 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|464.64||||464.64|302.02|418.18|97.57
100039|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L20 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|464.64||||464.64|188.18|418.18|97.57
100039|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L20 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|464.64||||464.64|302.02|418.18|97.57
100039|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L20 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|AETNA [1015]|COVENTRY HEALTHCARE [101502]|464.64||||464.64|418.18|418.18|97.57
100039|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L20 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|FIRST HEALTH [1375]|BENVEO/UCS [137512]|464.64||||464.64|394.94|418.18|97.57
100039|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L20 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|464.64||||464.64|418.18|418.18|97.57
100039|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L20 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|464.64||||464.64|148.22|418.18|97.57
100039|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L20 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|464.64||||464.64|418.18|418.18|97.57
100039|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L20 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|GROUP PENSION ADMIN [1450]|GPA [145000]|464.64||||464.64|325.25|418.18|97.57
100039|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L20 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|464.64||||464.64|418.18|418.18|97.57
100039|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L20 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|464.64||||464.64|418.18|418.18|97.57
100039|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L20 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|464.64||||464.64|418.18|418.18|97.57
100039|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L20 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|SAMBA HEALTH [2305]|SAMBA HEALTH [230500]|464.64||||464.64|325.25|418.18|97.57
100039|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L20 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|HEALTHNET [1495]|HEALTHNET [149500]|464.64||||464.64|418.18|418.18|97.57
100039|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L20 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|464.64||||464.64|418.18|418.18|97.57
100039|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L20 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|464.64||||464.64|418.18|418.18|97.57
100039|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L20 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|CIGNA [1260]|CIGNA - GREAT WEST [126009]|464.64||||464.64|325.25|418.18|97.57
100039|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L20 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|CORESOURCE [1315]|CORESOURCE [131500]|464.64||||464.64|418.18|418.18|97.57
100039|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L20 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|464.64||||464.64|418.18|418.18|97.57
100039|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L20 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|464.64||||464.64|||
100039|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L20 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|464.64||||464.64|||
100039|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L20 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|464.64||||464.64|||
100039|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L20 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|464.64||||464.64|||
100039|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L20 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|464.64||||464.64|||
100039|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L20 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|464.64||||464.64|||
100039|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L20 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|464.64||||464.64|||
100039|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L20 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|464.64||||464.64|||
100039|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L20 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|464.64||||464.64|||
100039|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L20 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|464.64||||464.64|||
100039|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L20 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|464.64||||464.64|||
100039|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L20 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|464.64||||464.64|||
100039|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L20 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|464.64||||464.64|||
100039|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L20 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|CHAMPVA [1240]|CHAMP VA [124000]|464.64||||464.64|||
100039|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L20 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|464.64||||464.64|||
100039|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L20 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|464.64||||464.64|||
100039|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L20 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|MULTIPLAN [1680]|HMA [168003]|464.64||||464.64|||
100039|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L20 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|AETNA [1015]|AETNA ACO WILCO [101532]|464.64||||464.64|||
100039|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L20 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|464.64||||464.64|||
100039|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L20 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|GEHA [1415]|GEHA - ASA [141503]|464.64||||464.64|||
100039|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L20 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|464.64||||464.64|||
100039|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L20 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|464.64||||464.64|||
100039|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L20 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|464.64||||464.64|||
100039|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L20 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|464.64||||464.64|||
100039|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L20 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|464.64||||464.64|||
100039|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L20 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|464.64||||464.64|||
100039|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L20 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|UNITED HEALTHCARE [2060]|UHC MEDICA CHOICE [206030]|464.64||||464.64|||
100039|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L20 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|464.64||||464.64|||
100039|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L20 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|UMR [2035]|UMR OPTIONS [203501]|464.64||||464.64|||
100040|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L25 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|464.64||||464.64|418.18|418.18|97.57
100040|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L25 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|464.64||||464.64|418.18|418.18|97.57
100040|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L25 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|464.64||||464.64|153.33|418.18|97.57
100040|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L25 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|464.64||||464.64|97.57|418.18|97.57
100040|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L25 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|464.64||||464.64|232.32|418.18|97.57
100040|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L25 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|464.64||||464.64|418.18|418.18|97.57
100040|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L25 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|464.64||||464.64|418.18|418.18|97.57
100040|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L25 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|CIGNA [1260]|CIGNA - GREAT WEST [126009]|464.64||||464.64|325.25|418.18|97.57
100040|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L25 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|464.64||||464.64|148.22|418.18|97.57
100040|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L25 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|464.64||||464.64|418.18|418.18|97.57
100040|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L25 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|464.64||||464.64|302.02|418.18|97.57
100040|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L25 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|464.64||||464.64|232.32|418.18|97.57
100040|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L25 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|464.64||||464.64|199.8|418.18|97.57
100040|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L25 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|HEALTHNET [1495]|HEALTHNET [149500]|464.64||||464.64|418.18|418.18|97.57
100040|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L25 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|464.64||||464.64|418.18|418.18|97.57
100040|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L25 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|464.64||||464.64|302.02|418.18|97.57
100040|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L25 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|464.64||||464.64|269.03|418.18|97.57
100040|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L25 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|464.64||||464.64|228.6|418.18|97.57
100040|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L25 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|464.64||||464.64|418.18|418.18|97.57
100040|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L25 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|464.64||||464.64|418.18|418.18|97.57
100040|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L25 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|AETNA [1015]|COVENTRY HEALTHCARE [101502]|464.64||||464.64|418.18|418.18|97.57
100040|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L25 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|MULTIPLAN [1680]|IHC HS [168011]|464.64||||464.64|418.18|418.18|97.57
100040|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L25 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|CORESOURCE [1315]|CORESOURCE [131500]|464.64||||464.64|418.18|418.18|97.57
100040|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L25 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|464.64||||464.64|357.77|418.18|97.57
100040|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L25 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|464.64||||464.64|418.18|418.18|97.57
100040|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L25 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|FIRST HEALTH [1375]|BENVEO/UCS [137512]|464.64||||464.64|394.94|418.18|97.57
100040|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L25 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|464.64||||464.64|302.02|418.18|97.57
100040|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L25 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|464.64||||464.64|418.18|418.18|97.57
100040|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L25 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|464.64||||464.64|418.18|418.18|97.57
100040|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L25 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|<Self-pay>|<Self-pay>|464.64||||464.64|139.39|418.18|97.57
100040|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L25 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|464.64||||464.64|418.18|418.18|97.57
100040|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L25 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|FIRST HEALTH [1375]|QUALCHOICE [137513]|464.64||||464.64|418.18|418.18|97.57
100040|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L25 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|464.64||||464.64|418.18|418.18|97.57
100040|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L25 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|FMH BENEFIT SERVICES [1390]|FMH [139000]|464.64||||464.64|418.18|418.18|97.57
100040|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L25 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|TRUSTMARK [2030]|STARMARK [203000]|464.64||||464.64|418.18|418.18|97.57
100040|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L25 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|464.64||||464.64|418.18|418.18|97.57
100040|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L25 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|GROUP PENSION ADMIN [1450]|GPA [145000]|464.64||||464.64|325.25|418.18|97.57
100040|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L25 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|AETNA [1015]|AMERICAN CONTINENTAL [101507]|464.64||||464.64|325.25|418.18|97.57
100040|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L25 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|464.64||||464.64|188.18|418.18|97.57
100040|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L25 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|464.64||||464.64|199.8|418.18|97.57
100040|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L25 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|SAMBA HEALTH [2305]|SAMBA HEALTH [230500]|464.64||||464.64|325.25|418.18|97.57
100040|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L25 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|464.64||||464.64|418.18|418.18|97.57
100040|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L25 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|464.64||||464.64|||
100040|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L25 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|MULTIPLAN [1680]|HMA [168003]|464.64||||464.64|||
100040|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L25 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|464.64||||464.64|||
100040|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L25 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|464.64||||464.64|||
100040|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L25 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|464.64||||464.64|||
100040|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L25 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|464.64||||464.64|||
100040|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L25 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|464.64||||464.64|||
100040|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L25 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|464.64||||464.64|||
100040|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L25 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|CHAMPVA [1240]|CHAMP VA [124000]|464.64||||464.64|||
100040|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L25 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|AETNA [1015]|AETNA ACO WILCO [101532]|464.64||||464.64|||
100040|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L25 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|464.64||||464.64|||
100040|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L25 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|464.64||||464.64|||
100040|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L25 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|464.64||||464.64|||
100040|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L25 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|464.64||||464.64|||
100040|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L25 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|464.64||||464.64|||
100040|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L25 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|GEHA [1415]|GEHA - ASA [141503]|464.64||||464.64|||
100040|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L25 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|UNITED HEALTHCARE [2060]|UHC MEDICA CHOICE [206030]|464.64||||464.64|||
100040|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L25 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|464.64||||464.64|||
100040|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L25 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|464.64||||464.64|||
100040|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L25 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|464.64||||464.64|||
100040|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L25 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|464.64||||464.64|||
100040|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L25 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|464.64||||464.64|||
100040|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L25 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|464.64||||464.64|||
100040|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L25 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|464.64||||464.64|||
100040|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L25 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|UMR [2035]|UMR OPTIONS [203501]|464.64||||464.64|||
100040|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L25 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|464.64||||464.64|||
100040|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L25 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|464.64||||464.64|||
100040|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L25 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|464.64||||464.64|||
100040|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L25 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|464.64||||464.64|||
100041|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L30 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|SAMBA HEALTH [2305]|SAMBA HEALTH [230500]|464.64||||464.64|325.25|418.18|97.57
100041|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L30 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|464.64||||464.64|418.18|418.18|97.57
100041|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L30 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|FIRST HEALTH [1375]|QUALCHOICE [137513]|464.64||||464.64|418.18|418.18|97.57
100041|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L30 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|464.64||||464.64|418.18|418.18|97.57
100041|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L30 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|464.64||||464.64|418.18|418.18|97.57
100041|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L30 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|FIRST HEALTH [1375]|BENVEO/UCS [137512]|464.64||||464.64|394.94|418.18|97.57
100041|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L30 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|TRUSTMARK [2030]|STARMARK [203000]|464.64||||464.64|418.18|418.18|97.57
100041|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L30 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|464.64||||464.64|302.02|418.18|97.57
100041|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L30 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|464.64||||464.64|302.02|418.18|97.57
100041|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L30 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|464.64||||464.64|188.18|418.18|97.57
100041|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L30 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|464.64||||464.64|418.18|418.18|97.57
100041|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L30 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|GROUP PENSION ADMIN [1450]|GPA [145000]|464.64||||464.64|325.25|418.18|97.57
100041|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L30 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|MULTIPLAN [1680]|IHC HS [168011]|464.64||||464.64|418.18|418.18|97.57
100041|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L30 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|AETNA [1015]|COVENTRY HEALTHCARE [101502]|464.64||||464.64|418.18|418.18|97.57
100041|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L30 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|464.64||||464.64|418.18|418.18|97.57
100041|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L30 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|464.64||||464.64|269.03|418.18|97.57
100041|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L30 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|464.64||||464.64|418.18|418.18|97.57
100041|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L30 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|464.64||||464.64|199.8|418.18|97.57
100041|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L30 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|464.64||||464.64|418.18|418.18|97.57
100041|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L30 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|464.64||||464.64|418.18|418.18|97.57
100041|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L30 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|464.64||||464.64|228.6|418.18|97.57
100041|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L30 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|CORESOURCE [1315]|CORESOURCE [131500]|464.64||||464.64|418.18|418.18|97.57
100041|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L30 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|AETNA [1015]|AMERICAN CONTINENTAL [101507]|464.64||||464.64|325.25|418.18|97.57
100041|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L30 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|464.64||||464.64|153.33|418.18|97.57
100041|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L30 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|464.64||||464.64|418.18|418.18|97.57
100041|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L30 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|464.64||||464.64|418.18|418.18|97.57
100041|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L30 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|464.64||||464.64|418.18|418.18|97.57
100041|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L30 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|<Self-pay>|<Self-pay>|464.64||||464.64|139.39|418.18|97.57
100041|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L30 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|HEALTHNET [1495]|HEALTHNET [149500]|464.64||||464.64|418.18|418.18|97.57
100041|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L30 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|CIGNA [1260]|CIGNA - GREAT WEST [126009]|464.64||||464.64|325.25|418.18|97.57
100041|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L30 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|464.64||||464.64|357.77|418.18|97.57
100041|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L30 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|464.64||||464.64|302.02|418.18|97.57
100041|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L30 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|464.64||||464.64|97.57|418.18|97.57
100041|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L30 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|464.64||||464.64|418.18|418.18|97.57
100041|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L30 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|464.64||||464.64|418.18|418.18|97.57
100041|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L30 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|464.64||||464.64|232.32|418.18|97.57
100041|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L30 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|464.64||||464.64|418.18|418.18|97.57
100041|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L30 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|464.64||||464.64|148.22|418.18|97.57
100041|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L30 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|464.64||||464.64|232.32|418.18|97.57
100041|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L30 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|464.64||||464.64|199.8|418.18|97.57
100041|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L30 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|FMH BENEFIT SERVICES [1390]|FMH [139000]|464.64||||464.64|418.18|418.18|97.57
100041|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L30 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|464.64||||464.64|418.18|418.18|97.57
100041|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L30 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|UNITED HEALTHCARE [2060]|UHC MEDICA CHOICE [206030]|464.64||||464.64|||
100041|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L30 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|464.64||||464.64|||
100041|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L30 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|464.64||||464.64|||
100041|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L30 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|GEHA [1415]|GEHA - ASA [141503]|464.64||||464.64|||
100041|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L30 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|464.64||||464.64|||
100041|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L30 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|AETNA [1015]|AETNA ACO WILCO [101532]|464.64||||464.64|||
100041|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L30 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|MULTIPLAN [1680]|HMA [168003]|464.64||||464.64|||
100041|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L30 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|464.64||||464.64|||
100041|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L30 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|464.64||||464.64|||
100041|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L30 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|464.64||||464.64|||
100041|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L30 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|464.64||||464.64|||
100041|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L30 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|464.64||||464.64|||
100041|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L30 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|464.64||||464.64|||
100041|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L30 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|464.64||||464.64|||
100041|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L30 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|464.64||||464.64|||
100041|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L30 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|464.64||||464.64|||
100041|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L30 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|UMR [2035]|UMR OPTIONS [203501]|464.64||||464.64|||
100041|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L30 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|464.64||||464.64|||
100041|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L30 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|464.64||||464.64|||
100041|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L30 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|464.64||||464.64|||
100041|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L30 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|464.64||||464.64|||
100041|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L30 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|464.64||||464.64|||
100041|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L30 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|464.64||||464.64|||
100041|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L30 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|464.64||||464.64|||
100041|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L30 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|464.64||||464.64|||
100041|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L30 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|464.64||||464.64|||
100041|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L30 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|CHAMPVA [1240]|CHAMP VA [124000]|464.64||||464.64|||
100041|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L30 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|464.64||||464.64|||
100041|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L30 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|464.64||||464.64|||
100042|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L35 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|HEALTHNET [1495]|HEALTHNET [149500]|464.64||||464.64|418.18|418.18|97.57
100042|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L35 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|464.64||||464.64|199.8|418.18|97.57
100042|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L35 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|464.64||||464.64|232.32|418.18|97.57
100042|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L35 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|464.64||||464.64|418.18|418.18|97.57
100042|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L35 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|464.64||||464.64|232.32|418.18|97.57
100042|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L35 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|464.64||||464.64|153.33|418.18|97.57
100042|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L35 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|FMH BENEFIT SERVICES [1390]|FMH [139000]|464.64||||464.64|418.18|418.18|97.57
100042|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L35 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|464.64||||464.64|418.18|418.18|97.57
100042|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L35 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|464.64||||464.64|418.18|418.18|97.57
100042|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L35 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|464.64||||464.64|418.18|418.18|97.57
100042|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L35 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|464.64||||464.64|148.22|418.18|97.57
100042|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L35 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|464.64||||464.64|418.18|418.18|97.57
100042|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L35 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|CORESOURCE [1315]|CORESOURCE [131500]|464.64||||464.64|418.18|418.18|97.57
100042|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L35 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|464.64||||464.64|302.02|418.18|97.57
100042|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L35 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|464.64||||464.64|418.18|418.18|97.57
100042|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L35 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|464.64||||464.64|418.18|418.18|97.57
100042|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L35 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|464.64||||464.64|97.57|418.18|97.57
100042|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L35 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|464.64||||464.64|228.6|418.18|97.57
100042|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L35 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|464.64||||464.64|199.8|418.18|97.57
100042|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L35 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|464.64||||464.64|357.77|418.18|97.57
100042|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L35 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|CIGNA [1260]|CIGNA - GREAT WEST [126009]|464.64||||464.64|325.25|418.18|97.57
100042|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L35 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|464.64||||464.64|302.02|418.18|97.57
100042|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L35 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|464.64||||464.64|418.18|418.18|97.57
100042|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L35 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|GROUP PENSION ADMIN [1450]|GPA [145000]|464.64||||464.64|325.25|418.18|97.57
100042|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L35 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|464.64||||464.64|302.02|418.18|97.57
100042|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L35 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|<Self-pay>|<Self-pay>|464.64||||464.64|139.39|418.18|97.57
100042|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L35 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|FIRST HEALTH [1375]|BENVEO/UCS [137512]|464.64||||464.64|394.94|418.18|97.57
100042|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L35 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|FIRST HEALTH [1375]|QUALCHOICE [137513]|464.64||||464.64|418.18|418.18|97.57
100042|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L35 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|TRUSTMARK [2030]|STARMARK [203000]|464.64||||464.64|418.18|418.18|97.57
100042|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L35 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|464.64||||464.64|418.18|418.18|97.57
100042|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L35 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|AETNA [1015]|AMERICAN CONTINENTAL [101507]|464.64||||464.64|325.25|418.18|97.57
100042|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L35 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|464.64||||464.64|418.18|418.18|97.57
100042|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L35 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|464.64||||464.64|418.18|418.18|97.57
100042|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L35 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|464.64||||464.64|188.18|418.18|97.57
100042|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L35 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|464.64||||464.64|418.18|418.18|97.57
100042|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L35 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|464.64||||464.64|418.18|418.18|97.57
100042|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L35 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|464.64||||464.64|418.18|418.18|97.57
100042|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L35 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|MULTIPLAN [1680]|IHC HS [168011]|464.64||||464.64|418.18|418.18|97.57
100042|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L35 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|AETNA [1015]|COVENTRY HEALTHCARE [101502]|464.64||||464.64|418.18|418.18|97.57
100042|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L35 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|SAMBA HEALTH [2305]|SAMBA HEALTH [230500]|464.64||||464.64|325.25|418.18|97.57
100042|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L35 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|464.64||||464.64|418.18|418.18|97.57
100042|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L35 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|464.64||||464.64|269.03|418.18|97.57
100042|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L35 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|464.64||||464.64|||
100042|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L35 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|464.64||||464.64|||
100042|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L35 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|464.64||||464.64|||
100042|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L35 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|464.64||||464.64|||
100042|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L35 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|464.64||||464.64|||
100042|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L35 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|464.64||||464.64|||
100042|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L35 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|CHAMPVA [1240]|CHAMP VA [124000]|464.64||||464.64|||
100042|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L35 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|464.64||||464.64|||
100042|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L35 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|464.64||||464.64|||
100042|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L35 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|464.64||||464.64|||
100042|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L35 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|464.64||||464.64|||
100042|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L35 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|464.64||||464.64|||
100042|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L35 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|464.64||||464.64|||
100042|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L35 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|MULTIPLAN [1680]|HMA [168003]|464.64||||464.64|||
100042|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L35 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|464.64||||464.64|||
100042|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L35 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|AETNA [1015]|AETNA ACO WILCO [101532]|464.64||||464.64|||
100042|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L35 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|464.64||||464.64|||
100042|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L35 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|464.64||||464.64|||
100042|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L35 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|464.64||||464.64|||
100042|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L35 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|464.64||||464.64|||
100042|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L35 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|UNITED HEALTHCARE [2060]|UHC MEDICA CHOICE [206030]|464.64||||464.64|||
100042|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L35 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|GEHA [1415]|GEHA - ASA [141503]|464.64||||464.64|||
100042|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L35 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|464.64||||464.64|||
100042|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L35 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|464.64||||464.64|||
100042|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L35 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|464.64||||464.64|||
100042|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L35 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|464.64||||464.64|||
100042|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L35 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|464.64||||464.64|||
100042|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L35 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|464.64||||464.64|||
100042|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L35 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|UMR [2035]|UMR OPTIONS [203501]|464.64||||464.64|||
100043|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L40 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|464.64||||464.64|418.18|418.18|97.57
100043|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L40 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|464.64||||464.64|418.18|418.18|97.57
100043|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L40 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|464.64||||464.64|232.32|418.18|97.57
100043|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L40 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|CORESOURCE [1315]|CORESOURCE [131500]|464.64||||464.64|418.18|418.18|97.57
100043|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L40 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|SAMBA HEALTH [2305]|SAMBA HEALTH [230500]|464.64||||464.64|325.25|418.18|97.57
100043|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L40 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|464.64||||464.64|418.18|418.18|97.57
100043|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L40 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|464.64||||464.64|418.18|418.18|97.57
100043|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L40 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|FIRST HEALTH [1375]|BENVEO/UCS [137512]|464.64||||464.64|394.94|418.18|97.57
100043|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L40 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|464.64||||464.64|302.02|418.18|97.57
100043|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L40 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|464.64||||464.64|302.02|418.18|97.57
100043|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L40 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|464.64||||464.64|418.18|418.18|97.57
100043|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L40 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|464.64||||464.64|188.18|418.18|97.57
100043|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L40 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|AETNA [1015]|COVENTRY HEALTHCARE [101502]|464.64||||464.64|418.18|418.18|97.57
100043|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L40 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|464.64||||464.64|418.18|418.18|97.57
100043|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L40 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|MULTIPLAN [1680]|IHC HS [168011]|464.64||||464.64|418.18|418.18|97.57
100043|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L40 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|464.64||||464.64|269.03|418.18|97.57
100043|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L40 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|FIRST HEALTH [1375]|QUALCHOICE [137513]|464.64||||464.64|418.18|418.18|97.57
100043|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L40 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|<Self-pay>|<Self-pay>|464.64||||464.64|139.39|418.18|97.57
100043|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L40 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|TRUSTMARK [2030]|STARMARK [203000]|464.64||||464.64|418.18|418.18|97.57
100043|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L40 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|464.64||||464.64|418.18|418.18|97.57
100043|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L40 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|464.64||||464.64|228.6|418.18|97.57
100043|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L40 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|AETNA [1015]|AMERICAN CONTINENTAL [101507]|464.64||||464.64|325.25|418.18|97.57
100043|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L40 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|464.64||||464.64|199.8|418.18|97.57
100043|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L40 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|GROUP PENSION ADMIN [1450]|GPA [145000]|464.64||||464.64|325.25|418.18|97.57
100043|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L40 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|464.64||||464.64|302.02|418.18|97.57
100043|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L40 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|464.64||||464.64|418.18|418.18|97.57
100043|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L40 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|464.64||||464.64|148.22|418.18|97.57
100043|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L40 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|464.64||||464.64|418.18|418.18|97.57
100043|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L40 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|464.64||||464.64|418.18|418.18|97.57
100043|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L40 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|464.64||||464.64|418.18|418.18|97.57
100043|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L40 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|464.64||||464.64|418.18|418.18|97.57
100043|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L40 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|HEALTHNET [1495]|HEALTHNET [149500]|464.64||||464.64|418.18|418.18|97.57
100043|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L40 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|464.64||||464.64|418.18|418.18|97.57
100043|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L40 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|464.64||||464.64|418.18|418.18|97.57
100043|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L40 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|FMH BENEFIT SERVICES [1390]|FMH [139000]|464.64||||464.64|418.18|418.18|97.57
100043|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L40 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|464.64||||464.64|418.18|418.18|97.57
100043|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L40 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|464.64||||464.64|97.57|418.18|97.57
100043|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L40 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|464.64||||464.64|232.32|418.18|97.57
100043|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L40 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|464.64||||464.64|153.33|418.18|97.57
100043|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L40 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|464.64||||464.64|357.77|418.18|97.57
100043|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L40 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|464.64||||464.64|199.8|418.18|97.57
100043|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L40 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|CIGNA [1260]|CIGNA - GREAT WEST [126009]|464.64||||464.64|325.25|418.18|97.57
100043|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L40 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|464.64||||464.64|||
100043|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L40 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|464.64||||464.64|||
100043|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L40 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|UNITED HEALTHCARE [2060]|UHC MEDICA CHOICE [206030]|464.64||||464.64|||
100043|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L40 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|464.64||||464.64|||
100043|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L40 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|464.64||||464.64|||
100043|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L40 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|UMR [2035]|UMR OPTIONS [203501]|464.64||||464.64|||
100043|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L40 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|464.64||||464.64|||
100043|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L40 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|464.64||||464.64|||
100043|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L40 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|464.64||||464.64|||
100043|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L40 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|464.64||||464.64|||
100043|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L40 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|MULTIPLAN [1680]|HMA [168003]|464.64||||464.64|||
100043|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L40 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|464.64||||464.64|||
100043|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L40 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|464.64||||464.64|||
100043|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L40 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|GEHA [1415]|GEHA - ASA [141503]|464.64||||464.64|||
100043|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L40 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|464.64||||464.64|||
100043|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L40 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|464.64||||464.64|||
100043|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L40 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|464.64||||464.64|||
100043|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L40 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|AETNA [1015]|AETNA ACO WILCO [101532]|464.64||||464.64|||
100043|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L40 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|464.64||||464.64|||
100043|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L40 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|464.64||||464.64|||
100043|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L40 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|464.64||||464.64|||
100043|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L40 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|464.64||||464.64|||
100043|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L40 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|CHAMPVA [1240]|CHAMP VA [124000]|464.64||||464.64|||
100043|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L40 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|464.64||||464.64|||
100043|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L40 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|464.64||||464.64|||
100043|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L40 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|464.64||||464.64|||
100043|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L40 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|464.64||||464.64|||
100043|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L40 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|464.64||||464.64|||
100043|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L40 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|464.64||||464.64|||
100044|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L45 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|464.64||||464.64|357.77|418.18|97.57
100044|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L45 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|464.64||||464.64|418.18|418.18|97.57
100044|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L45 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|464.64||||464.64|153.33|418.18|97.57
100044|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L45 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|464.64||||464.64|232.32|418.18|97.57
100044|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L45 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|HEALTHNET [1495]|HEALTHNET [149500]|464.64||||464.64|418.18|418.18|97.57
100044|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L45 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|464.64||||464.64|418.18|418.18|97.57
100044|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L45 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|464.64||||464.64|418.18|418.18|97.57
100044|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L45 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|CIGNA [1260]|CIGNA - GREAT WEST [126009]|464.64||||464.64|325.25|418.18|97.57
100044|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L45 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|464.64||||464.64|418.18|418.18|97.57
100044|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L45 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|FMH BENEFIT SERVICES [1390]|FMH [139000]|464.64||||464.64|418.18|418.18|97.57
100044|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L45 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|464.64||||464.64|97.57|418.18|97.57
100044|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L45 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|464.64||||464.64|232.32|418.18|97.57
100044|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L45 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|CORESOURCE [1315]|CORESOURCE [131500]|464.64||||464.64|418.18|418.18|97.57
100044|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L45 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|464.64||||464.64|148.22|418.18|97.57
100044|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L45 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|464.64||||464.64|302.02|418.18|97.57
100044|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L45 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|464.64||||464.64|199.8|418.18|97.57
100044|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L45 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|464.64||||464.64|199.8|418.18|97.57
100044|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L45 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|464.64||||464.64|418.18|418.18|97.57
100044|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L45 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|464.64||||464.64|418.18|418.18|97.57
100044|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L45 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|MULTIPLAN [1680]|IHC HS [168011]|464.64||||464.64|418.18|418.18|97.57
100044|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L45 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|464.64||||464.64|418.18|418.18|97.57
100044|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L45 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|464.64||||464.64|418.18|418.18|97.57
100044|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L45 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|FIRST HEALTH [1375]|BENVEO/UCS [137512]|464.64||||464.64|394.94|418.18|97.57
100044|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L45 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|464.64||||464.64|418.18|418.18|97.57
100044|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L45 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|FIRST HEALTH [1375]|QUALCHOICE [137513]|464.64||||464.64|418.18|418.18|97.57
100044|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L45 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|464.64||||464.64|228.6|418.18|97.57
100044|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L45 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|TRUSTMARK [2030]|STARMARK [203000]|464.64||||464.64|418.18|418.18|97.57
100044|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L45 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|464.64||||464.64|418.18|418.18|97.57
100044|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L45 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|SAMBA HEALTH [2305]|SAMBA HEALTH [230500]|464.64||||464.64|325.25|418.18|97.57
100044|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L45 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|AETNA [1015]|AMERICAN CONTINENTAL [101507]|464.64||||464.64|325.25|418.18|97.57
100044|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L45 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|464.64||||464.64|418.18|418.18|97.57
100044|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L45 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|GROUP PENSION ADMIN [1450]|GPA [145000]|464.64||||464.64|325.25|418.18|97.57
100044|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L45 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|464.64||||464.64|418.18|418.18|97.57
100044|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L45 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|<Self-pay>|<Self-pay>|464.64||||464.64|139.39|418.18|97.57
100044|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L45 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|464.64||||464.64|418.18|418.18|97.57
100044|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L45 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|464.64||||464.64|302.02|418.18|97.57
100044|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L45 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|464.64||||464.64|188.18|418.18|97.57
100044|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L45 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|464.64||||464.64|418.18|418.18|97.57
100044|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L45 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|AETNA [1015]|COVENTRY HEALTHCARE [101502]|464.64||||464.64|418.18|418.18|97.57
100044|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L45 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|464.64||||464.64|418.18|418.18|97.57
100044|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L45 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|464.64||||464.64|269.03|418.18|97.57
100044|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L45 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|464.64||||464.64|302.02|418.18|97.57
100044|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L45 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|464.64||||464.64|||
100044|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L45 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|464.64||||464.64|||
100044|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L45 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|464.64||||464.64|||
100044|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L45 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|464.64||||464.64|||
100044|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L45 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|464.64||||464.64|||
100044|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L45 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|464.64||||464.64|||
100044|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L45 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|464.64||||464.64|||
100044|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L45 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|CHAMPVA [1240]|CHAMP VA [124000]|464.64||||464.64|||
100044|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L45 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|464.64||||464.64|||
100044|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L45 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|464.64||||464.64|||
100044|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L45 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|464.64||||464.64|||
100044|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L45 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|464.64||||464.64|||
100044|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L45 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|464.64||||464.64|||
100044|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L45 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|464.64||||464.64|||
100044|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L45 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|464.64||||464.64|||
100044|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L45 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|464.64||||464.64|||
100044|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L45 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|464.64||||464.64|||
100044|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L45 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|UNITED HEALTHCARE [2060]|UHC MEDICA CHOICE [206030]|464.64||||464.64|||
100044|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L45 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|464.64||||464.64|||
100044|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L45 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|464.64||||464.64|||
100044|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L45 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|464.64||||464.64|||
100044|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L45 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|464.64||||464.64|||
100044|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L45 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|464.64||||464.64|||
100044|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L45 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|UMR [2035]|UMR OPTIONS [203501]|464.64||||464.64|||
100044|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L45 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|464.64||||464.64|||
100044|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L45 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|GEHA [1415]|GEHA - ASA [141503]|464.64||||464.64|||
100044|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L45 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|MULTIPLAN [1680]|HMA [168003]|464.64||||464.64|||
100044|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L45 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|AETNA [1015]|AETNA ACO WILCO [101532]|464.64||||464.64|||
100044|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L45 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|464.64||||464.64|||
100045|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L50 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|464.64||||464.64|418.18|418.18|97.57
100045|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L50 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|FIRST HEALTH [1375]|QUALCHOICE [137513]|464.64||||464.64|418.18|418.18|97.57
100045|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L50 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|FIRST HEALTH [1375]|BENVEO/UCS [137512]|464.64||||464.64|394.94|418.18|97.57
100045|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L50 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|464.64||||464.64|418.18|418.18|97.57
100045|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L50 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|TRUSTMARK [2030]|STARMARK [203000]|464.64||||464.64|418.18|418.18|97.57
100045|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L50 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|GROUP PENSION ADMIN [1450]|GPA [145000]|464.64||||464.64|325.25|418.18|97.57
100045|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L50 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|<Self-pay>|<Self-pay>|464.64||||464.64|139.39|418.18|97.57
100045|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L50 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|464.64||||464.64|418.18|418.18|97.57
100045|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L50 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|464.64||||464.64|302.02|418.18|97.57
100045|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L50 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|464.64||||464.64|269.03|418.18|97.57
100045|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L50 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|AETNA [1015]|AMERICAN CONTINENTAL [101507]|464.64||||464.64|325.25|418.18|97.57
100045|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L50 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|AETNA [1015]|COVENTRY HEALTHCARE [101502]|464.64||||464.64|418.18|418.18|97.57
100045|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L50 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|MULTIPLAN [1680]|IHC HS [168011]|464.64||||464.64|418.18|418.18|97.57
100045|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L50 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|464.64||||464.64|418.18|418.18|97.57
100045|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L50 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|464.64||||464.64|199.8|418.18|97.57
100045|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L50 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|464.64||||464.64|188.18|418.18|97.57
100045|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L50 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|464.64||||464.64|418.18|418.18|97.57
100045|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L50 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|464.64||||464.64|228.6|418.18|97.57
100045|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L50 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|464.64||||464.64|148.22|418.18|97.57
100045|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L50 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|CORESOURCE [1315]|CORESOURCE [131500]|464.64||||464.64|418.18|418.18|97.57
100045|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L50 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|464.64||||464.64|232.32|418.18|97.57
100045|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L50 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|464.64||||464.64|302.02|418.18|97.57
100045|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L50 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|464.64||||464.64|302.02|418.18|97.57
100045|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L50 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|464.64||||464.64|418.18|418.18|97.57
100045|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L50 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|464.64||||464.64|418.18|418.18|97.57
100045|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L50 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|464.64||||464.64|418.18|418.18|97.57
100045|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L50 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|CIGNA [1260]|CIGNA - GREAT WEST [126009]|464.64||||464.64|325.25|418.18|97.57
100045|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L50 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|464.64||||464.64|357.77|418.18|97.57
100045|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L50 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|464.64||||464.64|153.33|418.18|97.57
100045|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L50 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|464.64||||464.64|97.57|418.18|97.57
100045|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L50 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|464.64||||464.64|418.18|418.18|97.57
100045|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L50 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|464.64||||464.64|418.18|418.18|97.57
100045|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L50 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|464.64||||464.64|418.18|418.18|97.57
100045|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L50 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|SAMBA HEALTH [2305]|SAMBA HEALTH [230500]|464.64||||464.64|325.25|418.18|97.57
100045|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L50 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|464.64||||464.64|418.18|418.18|97.57
100045|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L50 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|464.64||||464.64|232.32|418.18|97.57
100045|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L50 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|HEALTHNET [1495]|HEALTHNET [149500]|464.64||||464.64|418.18|418.18|97.57
100045|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L50 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|464.64||||464.64|418.18|418.18|97.57
100045|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L50 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|464.64||||464.64|199.8|418.18|97.57
100045|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L50 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|464.64||||464.64|418.18|418.18|97.57
100045|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L50 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|FMH BENEFIT SERVICES [1390]|FMH [139000]|464.64||||464.64|418.18|418.18|97.57
100045|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L50 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|464.64||||464.64|418.18|418.18|97.57
100045|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L50 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|AETNA [1015]|AETNA ACO WILCO [101532]|464.64||||464.64|||
100045|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L50 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|464.64||||464.64|||
100045|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L50 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|464.64||||464.64|||
100045|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L50 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|UNITED HEALTHCARE [2060]|UHC MEDICA CHOICE [206030]|464.64||||464.64|||
100045|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L50 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|464.64||||464.64|||
100045|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L50 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|464.64||||464.64|||
100045|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L50 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|UMR [2035]|UMR OPTIONS [203501]|464.64||||464.64|||
100045|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L50 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|464.64||||464.64|||
100045|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L50 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|GEHA [1415]|GEHA - ASA [141503]|464.64||||464.64|||
100045|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L50 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|464.64||||464.64|||
100045|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L50 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|464.64||||464.64|||
100045|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L50 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|MULTIPLAN [1680]|HMA [168003]|464.64||||464.64|||
100045|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L50 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|464.64||||464.64|||
100045|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L50 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|464.64||||464.64|||
100045|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L50 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|464.64||||464.64|||
100045|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L50 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|464.64||||464.64|||
100045|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L50 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|464.64||||464.64|||
100045|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L50 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|464.64||||464.64|||
100045|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L50 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|464.64||||464.64|||
100045|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L50 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|464.64||||464.64|||
100045|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L50 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|464.64||||464.64|||
100045|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L50 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|464.64||||464.64|||
100045|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L50 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|464.64||||464.64|||
100045|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L50 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|464.64||||464.64|||
100045|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L50 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|CHAMPVA [1240]|CHAMP VA [124000]|464.64||||464.64|||
100045|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L50 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|464.64||||464.64|||
100045|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L50 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|464.64||||464.64|||
100045|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L50 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|464.64||||464.64|||
100045|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L50 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|464.64||||464.64|||
100070|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|KIT BONE GRAFT STRUCSURE CALCIUM PHOSPHATE OD7 GA 5 CC SYRINGE DISPENSER GUN CANNULA|MULTIPLAN [1680]|HMA [168003]|6205.40||||6205.40|2171.89|5584.86|1303.13
100070|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|KIT BONE GRAFT STRUCSURE CALCIUM PHOSPHATE OD7 GA 5 CC SYRINGE DISPENSER GUN CANNULA|FIRST HEALTH [1375]|BENVEO/UCS [137512]|6205.40||||6205.40|5274.59|5584.86|1303.13
100070|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|KIT BONE GRAFT STRUCSURE CALCIUM PHOSPHATE OD7 GA 5 CC SYRINGE DISPENSER GUN CANNULA|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|6205.40||||6205.40|5584.86|5584.86|1303.13
100070|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|KIT BONE GRAFT STRUCSURE CALCIUM PHOSPHATE OD7 GA 5 CC SYRINGE DISPENSER GUN CANNULA|SAMBA HEALTH [2305]|SAMBA HEALTH [230500]|6205.40||||6205.40|4343.78|5584.86|1303.13
100070|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|KIT BONE GRAFT STRUCSURE CALCIUM PHOSPHATE OD7 GA 5 CC SYRINGE DISPENSER GUN CANNULA|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|6205.40||||6205.40|5584.86|5584.86|1303.13
100070|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|KIT BONE GRAFT STRUCSURE CALCIUM PHOSPHATE OD7 GA 5 CC SYRINGE DISPENSER GUN CANNULA|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|6205.40||||6205.40|5584.86|5584.86|1303.13
100070|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|KIT BONE GRAFT STRUCSURE CALCIUM PHOSPHATE OD7 GA 5 CC SYRINGE DISPENSER GUN CANNULA|TRUSTMARK [2030]|STARMARK [203000]|6205.40||||6205.40|5584.86|5584.86|1303.13
100070|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|KIT BONE GRAFT STRUCSURE CALCIUM PHOSPHATE OD7 GA 5 CC SYRINGE DISPENSER GUN CANNULA|FIRST HEALTH [1375]|QUALCHOICE [137513]|6205.40||||6205.40|5584.86|5584.86|1303.13
100070|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|KIT BONE GRAFT STRUCSURE CALCIUM PHOSPHATE OD7 GA 5 CC SYRINGE DISPENSER GUN CANNULA|GROUP PENSION ADMIN [1450]|GPA [145000]|6205.40||||6205.40|4343.78|5584.86|1303.13
100070|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|KIT BONE GRAFT STRUCSURE CALCIUM PHOSPHATE OD7 GA 5 CC SYRINGE DISPENSER GUN CANNULA|<Self-pay>|<Self-pay>|6205.40||||6205.40|1861.62|5584.86|1303.13
100070|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|KIT BONE GRAFT STRUCSURE CALCIUM PHOSPHATE OD7 GA 5 CC SYRINGE DISPENSER GUN CANNULA|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|6205.40||||6205.40|4033.51|5584.86|1303.13
100070|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|KIT BONE GRAFT STRUCSURE CALCIUM PHOSPHATE OD7 GA 5 CC SYRINGE DISPENSER GUN CANNULA|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|6205.40||||6205.40|5584.86|5584.86|1303.13
100070|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|KIT BONE GRAFT STRUCSURE CALCIUM PHOSPHATE OD7 GA 5 CC SYRINGE DISPENSER GUN CANNULA|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|6205.40||||6205.40|4033.51|5584.86|1303.13
100070|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|KIT BONE GRAFT STRUCSURE CALCIUM PHOSPHATE OD7 GA 5 CC SYRINGE DISPENSER GUN CANNULA|MULTIPLAN [1680]|IHC HS [168011]|6205.40||||6205.40|5584.86|5584.86|1303.13
100070|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|KIT BONE GRAFT STRUCSURE CALCIUM PHOSPHATE OD7 GA 5 CC SYRINGE DISPENSER GUN CANNULA|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|6205.40||||6205.40|2171.89|5584.86|1303.13
100070|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|KIT BONE GRAFT STRUCSURE CALCIUM PHOSPHATE OD7 GA 5 CC SYRINGE DISPENSER GUN CANNULA|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|6205.40||||6205.40|5584.86|5584.86|1303.13
100070|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|KIT BONE GRAFT STRUCSURE CALCIUM PHOSPHATE OD7 GA 5 CC SYRINGE DISPENSER GUN CANNULA|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|6205.40||||6205.40|5584.86|5584.86|1303.13
100070|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|KIT BONE GRAFT STRUCSURE CALCIUM PHOSPHATE OD7 GA 5 CC SYRINGE DISPENSER GUN CANNULA|AETNA [1015]|AETNA ACO WILCO [101532]|6205.40||||6205.40|2171.89|5584.86|1303.13
100070|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|KIT BONE GRAFT STRUCSURE CALCIUM PHOSPHATE OD7 GA 5 CC SYRINGE DISPENSER GUN CANNULA|AETNA [1015]|COVENTRY HEALTHCARE [101502]|6205.40||||6205.40|5584.86|5584.86|1303.13
100070|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|KIT BONE GRAFT STRUCSURE CALCIUM PHOSPHATE OD7 GA 5 CC SYRINGE DISPENSER GUN CANNULA|CORESOURCE [1315]|CORESOURCE [131500]|6205.40||||6205.40|5584.86|5584.86|1303.13
100070|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|KIT BONE GRAFT STRUCSURE CALCIUM PHOSPHATE OD7 GA 5 CC SYRINGE DISPENSER GUN CANNULA|HEALTHNET [1495]|HEALTHNET [149500]|6205.40||||6205.40|5584.86|5584.86|1303.13
100070|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|KIT BONE GRAFT STRUCSURE CALCIUM PHOSPHATE OD7 GA 5 CC SYRINGE DISPENSER GUN CANNULA|CIGNA [1260]|CIGNA - GREAT WEST [126009]|6205.40||||6205.40|4343.78|5584.86|1303.13
100070|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|KIT BONE GRAFT STRUCSURE CALCIUM PHOSPHATE OD7 GA 5 CC SYRINGE DISPENSER GUN CANNULA|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|6205.40||||6205.40|2668.32|5584.86|1303.13
100070|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|KIT BONE GRAFT STRUCSURE CALCIUM PHOSPHATE OD7 GA 5 CC SYRINGE DISPENSER GUN CANNULA|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|6205.40||||6205.40|4778.16|5584.86|1303.13
100070|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|KIT BONE GRAFT STRUCSURE CALCIUM PHOSPHATE OD7 GA 5 CC SYRINGE DISPENSER GUN CANNULA|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|6205.40||||6205.40|3102.7|5584.86|1303.13
100070|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|KIT BONE GRAFT STRUCSURE CALCIUM PHOSPHATE OD7 GA 5 CC SYRINGE DISPENSER GUN CANNULA|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|6205.40||||6205.40|5584.86|5584.86|1303.13
100070|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|KIT BONE GRAFT STRUCSURE CALCIUM PHOSPHATE OD7 GA 5 CC SYRINGE DISPENSER GUN CANNULA|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|6205.40||||6205.40|3102.7|5584.86|1303.13
100070|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|KIT BONE GRAFT STRUCSURE CALCIUM PHOSPHATE OD7 GA 5 CC SYRINGE DISPENSER GUN CANNULA|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|6205.40||||6205.40|2047.78|5584.86|1303.13
100070|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|KIT BONE GRAFT STRUCSURE CALCIUM PHOSPHATE OD7 GA 5 CC SYRINGE DISPENSER GUN CANNULA|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|6205.40||||6205.40|5584.86|5584.86|1303.13
100070|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|KIT BONE GRAFT STRUCSURE CALCIUM PHOSPHATE OD7 GA 5 CC SYRINGE DISPENSER GUN CANNULA|FMH BENEFIT SERVICES [1390]|FMH [139000]|6205.40||||6205.40|5584.86|5584.86|1303.13
100070|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|KIT BONE GRAFT STRUCSURE CALCIUM PHOSPHATE OD7 GA 5 CC SYRINGE DISPENSER GUN CANNULA|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|6205.40||||6205.40|5584.86|5584.86|1303.13
100070|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|KIT BONE GRAFT STRUCSURE CALCIUM PHOSPHATE OD7 GA 5 CC SYRINGE DISPENSER GUN CANNULA|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|6205.40||||6205.40|5584.86|5584.86|1303.13
100070|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|KIT BONE GRAFT STRUCSURE CALCIUM PHOSPHATE OD7 GA 5 CC SYRINGE DISPENSER GUN CANNULA|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|6205.40||||6205.40|1979.52|5584.86|1303.13
100070|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|KIT BONE GRAFT STRUCSURE CALCIUM PHOSPHATE OD7 GA 5 CC SYRINGE DISPENSER GUN CANNULA|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|6205.40||||6205.40|1303.13|5584.86|1303.13
100070|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|KIT BONE GRAFT STRUCSURE CALCIUM PHOSPHATE OD7 GA 5 CC SYRINGE DISPENSER GUN CANNULA|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|6205.40||||6205.40|5584.86|5584.86|1303.13
100070|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|KIT BONE GRAFT STRUCSURE CALCIUM PHOSPHATE OD7 GA 5 CC SYRINGE DISPENSER GUN CANNULA|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|6205.40||||6205.40|5584.86|5584.86|1303.13
100070|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|KIT BONE GRAFT STRUCSURE CALCIUM PHOSPHATE OD7 GA 5 CC SYRINGE DISPENSER GUN CANNULA|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|6205.40||||6205.40|2171.89|5584.86|1303.13
100070|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|KIT BONE GRAFT STRUCSURE CALCIUM PHOSPHATE OD7 GA 5 CC SYRINGE DISPENSER GUN CANNULA|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|6205.40||||6205.40|4033.51|5584.86|1303.13
100070|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|KIT BONE GRAFT STRUCSURE CALCIUM PHOSPHATE OD7 GA 5 CC SYRINGE DISPENSER GUN CANNULA|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|6205.40||||6205.40|5584.86|5584.86|1303.13
100070|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|KIT BONE GRAFT STRUCSURE CALCIUM PHOSPHATE OD7 GA 5 CC SYRINGE DISPENSER GUN CANNULA|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|6205.40||||6205.40|5584.86|5584.86|1303.13
100070|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|KIT BONE GRAFT STRUCSURE CALCIUM PHOSPHATE OD7 GA 5 CC SYRINGE DISPENSER GUN CANNULA|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|6205.40||||6205.40|3592.93|5584.86|1303.13
100070|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|KIT BONE GRAFT STRUCSURE CALCIUM PHOSPHATE OD7 GA 5 CC SYRINGE DISPENSER GUN CANNULA|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|6205.40||||6205.40|3053.06|5584.86|1303.13
100070|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|KIT BONE GRAFT STRUCSURE CALCIUM PHOSPHATE OD7 GA 5 CC SYRINGE DISPENSER GUN CANNULA|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|6205.40||||6205.40|2668.32|5584.86|1303.13
100070|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|KIT BONE GRAFT STRUCSURE CALCIUM PHOSPHATE OD7 GA 5 CC SYRINGE DISPENSER GUN CANNULA|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|6205.40||||6205.40|2513.19|5584.86|1303.13
100070|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|KIT BONE GRAFT STRUCSURE CALCIUM PHOSPHATE OD7 GA 5 CC SYRINGE DISPENSER GUN CANNULA|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|6205.40||||6205.40|5584.86|5584.86|1303.13
100070|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|KIT BONE GRAFT STRUCSURE CALCIUM PHOSPHATE OD7 GA 5 CC SYRINGE DISPENSER GUN CANNULA|AETNA [1015]|AMERICAN CONTINENTAL [101507]|6205.40||||6205.40|4343.78|5584.86|1303.13
100070|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|KIT BONE GRAFT STRUCSURE CALCIUM PHOSPHATE OD7 GA 5 CC SYRINGE DISPENSER GUN CANNULA|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|6205.40||||6205.40|||
100070|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|KIT BONE GRAFT STRUCSURE CALCIUM PHOSPHATE OD7 GA 5 CC SYRINGE DISPENSER GUN CANNULA|GEHA [1415]|GEHA - ASA [141503]|6205.40||||6205.40|||
100070|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|KIT BONE GRAFT STRUCSURE CALCIUM PHOSPHATE OD7 GA 5 CC SYRINGE DISPENSER GUN CANNULA|UNITED HEALTHCARE [2060]|UHC MEDICA CHOICE [206030]|6205.40||||6205.40|||
100070|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|KIT BONE GRAFT STRUCSURE CALCIUM PHOSPHATE OD7 GA 5 CC SYRINGE DISPENSER GUN CANNULA|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|6205.40||||6205.40|||
100070|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|KIT BONE GRAFT STRUCSURE CALCIUM PHOSPHATE OD7 GA 5 CC SYRINGE DISPENSER GUN CANNULA|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|6205.40||||6205.40|||
100070|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|KIT BONE GRAFT STRUCSURE CALCIUM PHOSPHATE OD7 GA 5 CC SYRINGE DISPENSER GUN CANNULA|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|6205.40||||6205.40|||
100070|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|KIT BONE GRAFT STRUCSURE CALCIUM PHOSPHATE OD7 GA 5 CC SYRINGE DISPENSER GUN CANNULA|UMR [2035]|UMR OPTIONS [203501]|6205.40||||6205.40|||
100070|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|KIT BONE GRAFT STRUCSURE CALCIUM PHOSPHATE OD7 GA 5 CC SYRINGE DISPENSER GUN CANNULA|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|6205.40||||6205.40|||
100070|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|KIT BONE GRAFT STRUCSURE CALCIUM PHOSPHATE OD7 GA 5 CC SYRINGE DISPENSER GUN CANNULA|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|6205.40||||6205.40|||
100070|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|KIT BONE GRAFT STRUCSURE CALCIUM PHOSPHATE OD7 GA 5 CC SYRINGE DISPENSER GUN CANNULA|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|6205.40||||6205.40|||
100070|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|KIT BONE GRAFT STRUCSURE CALCIUM PHOSPHATE OD7 GA 5 CC SYRINGE DISPENSER GUN CANNULA|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|6205.40||||6205.40|||
100070|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|KIT BONE GRAFT STRUCSURE CALCIUM PHOSPHATE OD7 GA 5 CC SYRINGE DISPENSER GUN CANNULA|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|6205.40||||6205.40|||
100070|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|KIT BONE GRAFT STRUCSURE CALCIUM PHOSPHATE OD7 GA 5 CC SYRINGE DISPENSER GUN CANNULA|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|6205.40||||6205.40|||
100070|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|KIT BONE GRAFT STRUCSURE CALCIUM PHOSPHATE OD7 GA 5 CC SYRINGE DISPENSER GUN CANNULA|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|6205.40||||6205.40|||
100070|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|KIT BONE GRAFT STRUCSURE CALCIUM PHOSPHATE OD7 GA 5 CC SYRINGE DISPENSER GUN CANNULA|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|6205.40||||6205.40|||
100070|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|KIT BONE GRAFT STRUCSURE CALCIUM PHOSPHATE OD7 GA 5 CC SYRINGE DISPENSER GUN CANNULA|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|6205.40||||6205.40|||
100070|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|KIT BONE GRAFT STRUCSURE CALCIUM PHOSPHATE OD7 GA 5 CC SYRINGE DISPENSER GUN CANNULA|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|6205.40||||6205.40|||
100070|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|KIT BONE GRAFT STRUCSURE CALCIUM PHOSPHATE OD7 GA 5 CC SYRINGE DISPENSER GUN CANNULA|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|6205.40||||6205.40|||
100070|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|KIT BONE GRAFT STRUCSURE CALCIUM PHOSPHATE OD7 GA 5 CC SYRINGE DISPENSER GUN CANNULA|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|6205.40||||6205.40|||
100070|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|KIT BONE GRAFT STRUCSURE CALCIUM PHOSPHATE OD7 GA 5 CC SYRINGE DISPENSER GUN CANNULA|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|6205.40||||6205.40|||
100070|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|KIT BONE GRAFT STRUCSURE CALCIUM PHOSPHATE OD7 GA 5 CC SYRINGE DISPENSER GUN CANNULA|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|6205.40||||6205.40|||
100070|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|KIT BONE GRAFT STRUCSURE CALCIUM PHOSPHATE OD7 GA 5 CC SYRINGE DISPENSER GUN CANNULA|CHAMPVA [1240]|CHAMP VA [124000]|6205.40||||6205.40|||
100070|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|KIT BONE GRAFT STRUCSURE CALCIUM PHOSPHATE OD7 GA 5 CC SYRINGE DISPENSER GUN CANNULA|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|6205.40||||6205.40|||
100070|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|KIT BONE GRAFT STRUCSURE CALCIUM PHOSPHATE OD7 GA 5 CC SYRINGE DISPENSER GUN CANNULA|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|6205.40||||6205.40|||
100070|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|KIT BONE GRAFT STRUCSURE CALCIUM PHOSPHATE OD7 GA 5 CC SYRINGE DISPENSER GUN CANNULA|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|6205.40||||6205.40|||
100077|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL +0MM OFFSET C TAPER 28MM HIP HIGH PERFORMANCE BIOLOX DELTA|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|2192.00||||2192.00|1972.8|1972.8|460.32
100077|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL +0MM OFFSET C TAPER 28MM HIP HIGH PERFORMANCE BIOLOX DELTA|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|2192.00||||2192.00|1972.8|1972.8|460.32
100077|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL +0MM OFFSET C TAPER 28MM HIP HIGH PERFORMANCE BIOLOX DELTA|FIRST HEALTH [1375]|QUALCHOICE [137513]|2192.00||||2192.00|1972.8|1972.8|460.32
100077|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL +0MM OFFSET C TAPER 28MM HIP HIGH PERFORMANCE BIOLOX DELTA|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|2192.00||||2192.00|1424.8|1972.8|460.32
100077|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL +0MM OFFSET C TAPER 28MM HIP HIGH PERFORMANCE BIOLOX DELTA|MULTIPLAN [1680]|HMA [168003]|2192.00||||2192.00|767.2|1972.8|460.32
100077|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL +0MM OFFSET C TAPER 28MM HIP HIGH PERFORMANCE BIOLOX DELTA|AETNA [1015]|AMERICAN CONTINENTAL [101507]|2192.00||||2192.00|1534.4|1972.8|460.32
100077|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL +0MM OFFSET C TAPER 28MM HIP HIGH PERFORMANCE BIOLOX DELTA|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|2192.00||||2192.00|887.76|1972.8|460.32
100077|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL +0MM OFFSET C TAPER 28MM HIP HIGH PERFORMANCE BIOLOX DELTA|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|2192.00||||2192.00|942.56|1972.8|460.32
100077|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL +0MM OFFSET C TAPER 28MM HIP HIGH PERFORMANCE BIOLOX DELTA|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|2192.00||||2192.00|767.2|1972.8|460.32
100077|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL +0MM OFFSET C TAPER 28MM HIP HIGH PERFORMANCE BIOLOX DELTA|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|2192.00||||2192.00|1972.8|1972.8|460.32
100077|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL +0MM OFFSET C TAPER 28MM HIP HIGH PERFORMANCE BIOLOX DELTA|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|2192.00||||2192.00|1972.8|1972.8|460.32
100077|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL +0MM OFFSET C TAPER 28MM HIP HIGH PERFORMANCE BIOLOX DELTA|HEALTHNET [1495]|HEALTHNET [149500]|2192.00||||2192.00|1972.8|1972.8|460.32
100077|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL +0MM OFFSET C TAPER 28MM HIP HIGH PERFORMANCE BIOLOX DELTA|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|2192.00||||2192.00|1972.8|1972.8|460.32
100077|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL +0MM OFFSET C TAPER 28MM HIP HIGH PERFORMANCE BIOLOX DELTA|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|2192.00||||2192.00|1972.8|1972.8|460.32
100077|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL +0MM OFFSET C TAPER 28MM HIP HIGH PERFORMANCE BIOLOX DELTA|FMH BENEFIT SERVICES [1390]|FMH [139000]|2192.00||||2192.00|1972.8|1972.8|460.32
100077|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL +0MM OFFSET C TAPER 28MM HIP HIGH PERFORMANCE BIOLOX DELTA|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|2192.00||||2192.00|460.32|1972.8|460.32
100077|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL +0MM OFFSET C TAPER 28MM HIP HIGH PERFORMANCE BIOLOX DELTA|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|2192.00||||2192.00|1096|1972.8|460.32
100077|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL +0MM OFFSET C TAPER 28MM HIP HIGH PERFORMANCE BIOLOX DELTA|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|2192.00||||2192.00|723.36|1972.8|460.32
100077|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL +0MM OFFSET C TAPER 28MM HIP HIGH PERFORMANCE BIOLOX DELTA|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|2192.00||||2192.00|1972.8|1972.8|460.32
100077|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL +0MM OFFSET C TAPER 28MM HIP HIGH PERFORMANCE BIOLOX DELTA|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|2192.00||||2192.00|1096|1972.8|460.32
100077|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL +0MM OFFSET C TAPER 28MM HIP HIGH PERFORMANCE BIOLOX DELTA|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|2192.00||||2192.00|1687.84|1972.8|460.32
100077|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL +0MM OFFSET C TAPER 28MM HIP HIGH PERFORMANCE BIOLOX DELTA|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|2192.00||||2192.00|1972.8|1972.8|460.32
100077|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL +0MM OFFSET C TAPER 28MM HIP HIGH PERFORMANCE BIOLOX DELTA|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|2192.00||||2192.00|942.56|1972.8|460.32
100077|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL +0MM OFFSET C TAPER 28MM HIP HIGH PERFORMANCE BIOLOX DELTA|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|2192.00||||2192.00|699.25|1972.8|460.32
100077|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL +0MM OFFSET C TAPER 28MM HIP HIGH PERFORMANCE BIOLOX DELTA|CORESOURCE [1315]|CORESOURCE [131500]|2192.00||||2192.00|1972.8|1972.8|460.32
100077|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL +0MM OFFSET C TAPER 28MM HIP HIGH PERFORMANCE BIOLOX DELTA|CIGNA [1260]|CIGNA - GREAT WEST [126009]|2192.00||||2192.00|1534.4|1972.8|460.32
100077|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL +0MM OFFSET C TAPER 28MM HIP HIGH PERFORMANCE BIOLOX DELTA|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|2192.00||||2192.00|1424.8|1972.8|460.32
100077|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL +0MM OFFSET C TAPER 28MM HIP HIGH PERFORMANCE BIOLOX DELTA|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|2192.00||||2192.00|1972.8|1972.8|460.32
100077|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL +0MM OFFSET C TAPER 28MM HIP HIGH PERFORMANCE BIOLOX DELTA|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|2192.00||||2192.00|1972.8|1972.8|460.32
100077|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL +0MM OFFSET C TAPER 28MM HIP HIGH PERFORMANCE BIOLOX DELTA|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|2192.00||||2192.00|1078.46|1972.8|460.32
100077|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL +0MM OFFSET C TAPER 28MM HIP HIGH PERFORMANCE BIOLOX DELTA|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|2192.00||||2192.00|1269.17|1972.8|460.32
100077|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL +0MM OFFSET C TAPER 28MM HIP HIGH PERFORMANCE BIOLOX DELTA|AETNA [1015]|AETNA ACO WILCO [101532]|2192.00||||2192.00|767.2|1972.8|460.32
100077|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL +0MM OFFSET C TAPER 28MM HIP HIGH PERFORMANCE BIOLOX DELTA|AETNA [1015]|COVENTRY HEALTHCARE [101502]|2192.00||||2192.00|1972.8|1972.8|460.32
100077|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL +0MM OFFSET C TAPER 28MM HIP HIGH PERFORMANCE BIOLOX DELTA|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|2192.00||||2192.00|1972.8|1972.8|460.32
100077|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL +0MM OFFSET C TAPER 28MM HIP HIGH PERFORMANCE BIOLOX DELTA|MULTIPLAN [1680]|IHC HS [168011]|2192.00||||2192.00|1972.8|1972.8|460.32
100077|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL +0MM OFFSET C TAPER 28MM HIP HIGH PERFORMANCE BIOLOX DELTA|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|2192.00||||2192.00|1972.8|1972.8|460.32
100077|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL +0MM OFFSET C TAPER 28MM HIP HIGH PERFORMANCE BIOLOX DELTA|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|2192.00||||2192.00|767.2|1972.8|460.32
100077|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL +0MM OFFSET C TAPER 28MM HIP HIGH PERFORMANCE BIOLOX DELTA|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|2192.00||||2192.00|1972.8|1972.8|460.32
100077|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL +0MM OFFSET C TAPER 28MM HIP HIGH PERFORMANCE BIOLOX DELTA|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|2192.00||||2192.00|1424.8|1972.8|460.32
100077|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL +0MM OFFSET C TAPER 28MM HIP HIGH PERFORMANCE BIOLOX DELTA|<Self-pay>|<Self-pay>|2192.00||||2192.00|657.6|1972.8|460.32
100077|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL +0MM OFFSET C TAPER 28MM HIP HIGH PERFORMANCE BIOLOX DELTA|FIRST HEALTH [1375]|BENVEO/UCS [137512]|2192.00||||2192.00|1863.2|1972.8|460.32
100077|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL +0MM OFFSET C TAPER 28MM HIP HIGH PERFORMANCE BIOLOX DELTA|GROUP PENSION ADMIN [1450]|GPA [145000]|2192.00||||2192.00|1534.4|1972.8|460.32
100077|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL +0MM OFFSET C TAPER 28MM HIP HIGH PERFORMANCE BIOLOX DELTA|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|2192.00||||2192.00|1972.8|1972.8|460.32
100077|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL +0MM OFFSET C TAPER 28MM HIP HIGH PERFORMANCE BIOLOX DELTA|TRUSTMARK [2030]|STARMARK [203000]|2192.00||||2192.00|1972.8|1972.8|460.32
100077|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL +0MM OFFSET C TAPER 28MM HIP HIGH PERFORMANCE BIOLOX DELTA|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|2192.00||||2192.00|1972.8|1972.8|460.32
100077|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL +0MM OFFSET C TAPER 28MM HIP HIGH PERFORMANCE BIOLOX DELTA|SAMBA HEALTH [2305]|SAMBA HEALTH [230500]|2192.00||||2192.00|1534.4|1972.8|460.32
100077|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL +0MM OFFSET C TAPER 28MM HIP HIGH PERFORMANCE BIOLOX DELTA|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|2192.00||||2192.00|||
100077|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL +0MM OFFSET C TAPER 28MM HIP HIGH PERFORMANCE BIOLOX DELTA|UNITED HEALTHCARE [2060]|UHC MEDICA CHOICE [206030]|2192.00||||2192.00|||
100077|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL +0MM OFFSET C TAPER 28MM HIP HIGH PERFORMANCE BIOLOX DELTA|GEHA [1415]|GEHA - ASA [141503]|2192.00||||2192.00|||
100077|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL +0MM OFFSET C TAPER 28MM HIP HIGH PERFORMANCE BIOLOX DELTA|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|2192.00||||2192.00|||
100077|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL +0MM OFFSET C TAPER 28MM HIP HIGH PERFORMANCE BIOLOX DELTA|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|2192.00||||2192.00|||
100077|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL +0MM OFFSET C TAPER 28MM HIP HIGH PERFORMANCE BIOLOX DELTA|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|2192.00||||2192.00|||
100077|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL +0MM OFFSET C TAPER 28MM HIP HIGH PERFORMANCE BIOLOX DELTA|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|2192.00||||2192.00|||
100077|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL +0MM OFFSET C TAPER 28MM HIP HIGH PERFORMANCE BIOLOX DELTA|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|2192.00||||2192.00|||
100077|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL +0MM OFFSET C TAPER 28MM HIP HIGH PERFORMANCE BIOLOX DELTA|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|2192.00||||2192.00|||
100077|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL +0MM OFFSET C TAPER 28MM HIP HIGH PERFORMANCE BIOLOX DELTA|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|2192.00||||2192.00|||
100077|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL +0MM OFFSET C TAPER 28MM HIP HIGH PERFORMANCE BIOLOX DELTA|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|2192.00||||2192.00|||
100077|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL +0MM OFFSET C TAPER 28MM HIP HIGH PERFORMANCE BIOLOX DELTA|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|2192.00||||2192.00|||
100077|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL +0MM OFFSET C TAPER 28MM HIP HIGH PERFORMANCE BIOLOX DELTA|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|2192.00||||2192.00|||
100077|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL +0MM OFFSET C TAPER 28MM HIP HIGH PERFORMANCE BIOLOX DELTA|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|2192.00||||2192.00|||
100077|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL +0MM OFFSET C TAPER 28MM HIP HIGH PERFORMANCE BIOLOX DELTA|CHAMPVA [1240]|CHAMP VA [124000]|2192.00||||2192.00|||
100077|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL +0MM OFFSET C TAPER 28MM HIP HIGH PERFORMANCE BIOLOX DELTA|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|2192.00||||2192.00|||
100077|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL +0MM OFFSET C TAPER 28MM HIP HIGH PERFORMANCE BIOLOX DELTA|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|2192.00||||2192.00|||
100077|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL +0MM OFFSET C TAPER 28MM HIP HIGH PERFORMANCE BIOLOX DELTA|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|2192.00||||2192.00|||
100077|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL +0MM OFFSET C TAPER 28MM HIP HIGH PERFORMANCE BIOLOX DELTA|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|2192.00||||2192.00|||
100077|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL +0MM OFFSET C TAPER 28MM HIP HIGH PERFORMANCE BIOLOX DELTA|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|2192.00||||2192.00|||
100077|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL +0MM OFFSET C TAPER 28MM HIP HIGH PERFORMANCE BIOLOX DELTA|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|2192.00||||2192.00|||
100077|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL +0MM OFFSET C TAPER 28MM HIP HIGH PERFORMANCE BIOLOX DELTA|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|2192.00||||2192.00|||
100077|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL +0MM OFFSET C TAPER 28MM HIP HIGH PERFORMANCE BIOLOX DELTA|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|2192.00||||2192.00|||
100077|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL +0MM OFFSET C TAPER 28MM HIP HIGH PERFORMANCE BIOLOX DELTA|UMR [2035]|UMR OPTIONS [203501]|2192.00||||2192.00|||
100077|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL +0MM OFFSET C TAPER 28MM HIP HIGH PERFORMANCE BIOLOX DELTA|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|2192.00||||2192.00|||
100078|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL +5MM OFFSET C TAPER 28MM HIP HIGH PERFORMANCE BIOLOX DELTA|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|2192.00||||2192.00|1972.8|1972.8|460.32
100078|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL +5MM OFFSET C TAPER 28MM HIP HIGH PERFORMANCE BIOLOX DELTA|FMH BENEFIT SERVICES [1390]|FMH [139000]|2192.00||||2192.00|1972.8|1972.8|460.32
100078|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL +5MM OFFSET C TAPER 28MM HIP HIGH PERFORMANCE BIOLOX DELTA|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|2192.00||||2192.00|1687.84|1972.8|460.32
100078|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL +5MM OFFSET C TAPER 28MM HIP HIGH PERFORMANCE BIOLOX DELTA|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|2192.00||||2192.00|1096|1972.8|460.32
100078|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL +5MM OFFSET C TAPER 28MM HIP HIGH PERFORMANCE BIOLOX DELTA|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|2192.00||||2192.00|1972.8|1972.8|460.32
100078|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL +5MM OFFSET C TAPER 28MM HIP HIGH PERFORMANCE BIOLOX DELTA|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|2192.00||||2192.00|1096|1972.8|460.32
100078|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL +5MM OFFSET C TAPER 28MM HIP HIGH PERFORMANCE BIOLOX DELTA|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|2192.00||||2192.00|460.32|1972.8|460.32
100078|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL +5MM OFFSET C TAPER 28MM HIP HIGH PERFORMANCE BIOLOX DELTA|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|2192.00||||2192.00|723.36|1972.8|460.32
100078|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL +5MM OFFSET C TAPER 28MM HIP HIGH PERFORMANCE BIOLOX DELTA|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|2192.00||||2192.00|1972.8|1972.8|460.32
100078|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL +5MM OFFSET C TAPER 28MM HIP HIGH PERFORMANCE BIOLOX DELTA|CIGNA [1260]|CIGNA - GREAT WEST [126009]|2192.00||||2192.00|1534.4|1972.8|460.32
100078|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL +5MM OFFSET C TAPER 28MM HIP HIGH PERFORMANCE BIOLOX DELTA|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|2192.00||||2192.00|1972.8|1972.8|460.32
100078|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL +5MM OFFSET C TAPER 28MM HIP HIGH PERFORMANCE BIOLOX DELTA|HEALTHNET [1495]|HEALTHNET [149500]|2192.00||||2192.00|1972.8|1972.8|460.32
100078|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL +5MM OFFSET C TAPER 28MM HIP HIGH PERFORMANCE BIOLOX DELTA|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|2192.00||||2192.00|699.25|1972.8|460.32
100078|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL +5MM OFFSET C TAPER 28MM HIP HIGH PERFORMANCE BIOLOX DELTA|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|2192.00||||2192.00|1972.8|1972.8|460.32
100078|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL +5MM OFFSET C TAPER 28MM HIP HIGH PERFORMANCE BIOLOX DELTA|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|2192.00||||2192.00|1972.8|1972.8|460.32
100078|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL +5MM OFFSET C TAPER 28MM HIP HIGH PERFORMANCE BIOLOX DELTA|CORESOURCE [1315]|CORESOURCE [131500]|2192.00||||2192.00|1972.8|1972.8|460.32
100078|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL +5MM OFFSET C TAPER 28MM HIP HIGH PERFORMANCE BIOLOX DELTA|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|2192.00||||2192.00|767.2|1972.8|460.32
100078|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL +5MM OFFSET C TAPER 28MM HIP HIGH PERFORMANCE BIOLOX DELTA|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|2192.00||||2192.00|1424.8|1972.8|460.32
100078|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL +5MM OFFSET C TAPER 28MM HIP HIGH PERFORMANCE BIOLOX DELTA|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|2192.00||||2192.00|1972.8|1972.8|460.32
100078|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL +5MM OFFSET C TAPER 28MM HIP HIGH PERFORMANCE BIOLOX DELTA|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|2192.00||||2192.00|1972.8|1972.8|460.32
100078|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL +5MM OFFSET C TAPER 28MM HIP HIGH PERFORMANCE BIOLOX DELTA|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|2192.00||||2192.00|1078.46|1972.8|460.32
100078|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL +5MM OFFSET C TAPER 28MM HIP HIGH PERFORMANCE BIOLOX DELTA|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|2192.00||||2192.00|887.76|1972.8|460.32
100078|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL +5MM OFFSET C TAPER 28MM HIP HIGH PERFORMANCE BIOLOX DELTA|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|2192.00||||2192.00|1972.8|1972.8|460.32
100078|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL +5MM OFFSET C TAPER 28MM HIP HIGH PERFORMANCE BIOLOX DELTA|AETNA [1015]|AMERICAN CONTINENTAL [101507]|2192.00||||2192.00|1534.4|1972.8|460.32
100078|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL +5MM OFFSET C TAPER 28MM HIP HIGH PERFORMANCE BIOLOX DELTA|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|2192.00||||2192.00|767.2|1972.8|460.32
100078|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL +5MM OFFSET C TAPER 28MM HIP HIGH PERFORMANCE BIOLOX DELTA|MULTIPLAN [1680]|HMA [168003]|2192.00||||2192.00|767.2|1972.8|460.32
100078|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL +5MM OFFSET C TAPER 28MM HIP HIGH PERFORMANCE BIOLOX DELTA|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|2192.00||||2192.00|1972.8|1972.8|460.32
100078|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL +5MM OFFSET C TAPER 28MM HIP HIGH PERFORMANCE BIOLOX DELTA|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|2192.00||||2192.00|1424.8|1972.8|460.32
100078|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL +5MM OFFSET C TAPER 28MM HIP HIGH PERFORMANCE BIOLOX DELTA|<Self-pay>|<Self-pay>|2192.00||||2192.00|657.6|1972.8|460.32
100078|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL +5MM OFFSET C TAPER 28MM HIP HIGH PERFORMANCE BIOLOX DELTA|FIRST HEALTH [1375]|QUALCHOICE [137513]|2192.00||||2192.00|1972.8|1972.8|460.32
100078|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL +5MM OFFSET C TAPER 28MM HIP HIGH PERFORMANCE BIOLOX DELTA|FIRST HEALTH [1375]|BENVEO/UCS [137512]|2192.00||||2192.00|1863.2|1972.8|460.32
100078|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL +5MM OFFSET C TAPER 28MM HIP HIGH PERFORMANCE BIOLOX DELTA|MULTIPLAN [1680]|IHC HS [168011]|2192.00||||2192.00|1972.8|1972.8|460.32
100078|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL +5MM OFFSET C TAPER 28MM HIP HIGH PERFORMANCE BIOLOX DELTA|GROUP PENSION ADMIN [1450]|GPA [145000]|2192.00||||2192.00|1534.4|1972.8|460.32
100078|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL +5MM OFFSET C TAPER 28MM HIP HIGH PERFORMANCE BIOLOX DELTA|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|2192.00||||2192.00|1424.8|1972.8|460.32
100078|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL +5MM OFFSET C TAPER 28MM HIP HIGH PERFORMANCE BIOLOX DELTA|AETNA [1015]|AETNA ACO WILCO [101532]|2192.00||||2192.00|767.2|1972.8|460.32
100078|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL +5MM OFFSET C TAPER 28MM HIP HIGH PERFORMANCE BIOLOX DELTA|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|2192.00||||2192.00|1972.8|1972.8|460.32
100078|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL +5MM OFFSET C TAPER 28MM HIP HIGH PERFORMANCE BIOLOX DELTA|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|2192.00||||2192.00|942.56|1972.8|460.32
100078|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL +5MM OFFSET C TAPER 28MM HIP HIGH PERFORMANCE BIOLOX DELTA|TRUSTMARK [2030]|STARMARK [203000]|2192.00||||2192.00|1972.8|1972.8|460.32
100078|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL +5MM OFFSET C TAPER 28MM HIP HIGH PERFORMANCE BIOLOX DELTA|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|2192.00||||2192.00|942.56|1972.8|460.32
100078|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL +5MM OFFSET C TAPER 28MM HIP HIGH PERFORMANCE BIOLOX DELTA|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|2192.00||||2192.00|1972.8|1972.8|460.32
100078|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL +5MM OFFSET C TAPER 28MM HIP HIGH PERFORMANCE BIOLOX DELTA|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|2192.00||||2192.00|1269.17|1972.8|460.32
100078|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL +5MM OFFSET C TAPER 28MM HIP HIGH PERFORMANCE BIOLOX DELTA|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|2192.00||||2192.00|1972.8|1972.8|460.32
100078|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL +5MM OFFSET C TAPER 28MM HIP HIGH PERFORMANCE BIOLOX DELTA|SAMBA HEALTH [2305]|SAMBA HEALTH [230500]|2192.00||||2192.00|1534.4|1972.8|460.32
100078|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL +5MM OFFSET C TAPER 28MM HIP HIGH PERFORMANCE BIOLOX DELTA|AETNA [1015]|COVENTRY HEALTHCARE [101502]|2192.00||||2192.00|1972.8|1972.8|460.32
100078|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL +5MM OFFSET C TAPER 28MM HIP HIGH PERFORMANCE BIOLOX DELTA|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|2192.00||||2192.00|1972.8|1972.8|460.32
100078|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL +5MM OFFSET C TAPER 28MM HIP HIGH PERFORMANCE BIOLOX DELTA|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|2192.00||||2192.00|1972.8|1972.8|460.32
100078|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL +5MM OFFSET C TAPER 28MM HIP HIGH PERFORMANCE BIOLOX DELTA|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|2192.00||||2192.00|||
100078|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL +5MM OFFSET C TAPER 28MM HIP HIGH PERFORMANCE BIOLOX DELTA|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|2192.00||||2192.00|||
100078|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL +5MM OFFSET C TAPER 28MM HIP HIGH PERFORMANCE BIOLOX DELTA|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|2192.00||||2192.00|||
100078|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL +5MM OFFSET C TAPER 28MM HIP HIGH PERFORMANCE BIOLOX DELTA|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|2192.00||||2192.00|||
100078|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL +5MM OFFSET C TAPER 28MM HIP HIGH PERFORMANCE BIOLOX DELTA|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|2192.00||||2192.00|||
100078|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL +5MM OFFSET C TAPER 28MM HIP HIGH PERFORMANCE BIOLOX DELTA|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|2192.00||||2192.00|||
100078|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL +5MM OFFSET C TAPER 28MM HIP HIGH PERFORMANCE BIOLOX DELTA|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|2192.00||||2192.00|||
100078|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL +5MM OFFSET C TAPER 28MM HIP HIGH PERFORMANCE BIOLOX DELTA|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|2192.00||||2192.00|||
100078|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL +5MM OFFSET C TAPER 28MM HIP HIGH PERFORMANCE BIOLOX DELTA|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|2192.00||||2192.00|||
100078|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL +5MM OFFSET C TAPER 28MM HIP HIGH PERFORMANCE BIOLOX DELTA|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|2192.00||||2192.00|||
100078|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL +5MM OFFSET C TAPER 28MM HIP HIGH PERFORMANCE BIOLOX DELTA|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|2192.00||||2192.00|||
100078|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL +5MM OFFSET C TAPER 28MM HIP HIGH PERFORMANCE BIOLOX DELTA|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|2192.00||||2192.00|||
100078|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL +5MM OFFSET C TAPER 28MM HIP HIGH PERFORMANCE BIOLOX DELTA|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|2192.00||||2192.00|||
100078|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL +5MM OFFSET C TAPER 28MM HIP HIGH PERFORMANCE BIOLOX DELTA|CHAMPVA [1240]|CHAMP VA [124000]|2192.00||||2192.00|||
100078|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL +5MM OFFSET C TAPER 28MM HIP HIGH PERFORMANCE BIOLOX DELTA|GEHA [1415]|GEHA - ASA [141503]|2192.00||||2192.00|||
100078|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL +5MM OFFSET C TAPER 28MM HIP HIGH PERFORMANCE BIOLOX DELTA|UNITED HEALTHCARE [2060]|UHC MEDICA CHOICE [206030]|2192.00||||2192.00|||
100078|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL +5MM OFFSET C TAPER 28MM HIP HIGH PERFORMANCE BIOLOX DELTA|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|2192.00||||2192.00|||
100078|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL +5MM OFFSET C TAPER 28MM HIP HIGH PERFORMANCE BIOLOX DELTA|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|2192.00||||2192.00|||
100078|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL +5MM OFFSET C TAPER 28MM HIP HIGH PERFORMANCE BIOLOX DELTA|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|2192.00||||2192.00|||
100078|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL +5MM OFFSET C TAPER 28MM HIP HIGH PERFORMANCE BIOLOX DELTA|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|2192.00||||2192.00|||
100078|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL +5MM OFFSET C TAPER 28MM HIP HIGH PERFORMANCE BIOLOX DELTA|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|2192.00||||2192.00|||
100078|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL +5MM OFFSET C TAPER 28MM HIP HIGH PERFORMANCE BIOLOX DELTA|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|2192.00||||2192.00|||
100078|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL +5MM OFFSET C TAPER 28MM HIP HIGH PERFORMANCE BIOLOX DELTA|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|2192.00||||2192.00|||
100078|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL +5MM OFFSET C TAPER 28MM HIP HIGH PERFORMANCE BIOLOX DELTA|UMR [2035]|UMR OPTIONS [203501]|2192.00||||2192.00|||
100078|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL +5MM OFFSET C TAPER 28MM HIP HIGH PERFORMANCE BIOLOX DELTA|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|2192.00||||2192.00|||
100079|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL +2.5MM OFFSET C TAPER 28MM HIP HIGH PERFORMANCE BIOLOX DELTA|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|2192.00||||2192.00|1972.8|1972.8|460.32
100079|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL +2.5MM OFFSET C TAPER 28MM HIP HIGH PERFORMANCE BIOLOX DELTA|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|2192.00||||2192.00|1972.8|1972.8|460.32
100079|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL +2.5MM OFFSET C TAPER 28MM HIP HIGH PERFORMANCE BIOLOX DELTA|TRUSTMARK [2030]|STARMARK [203000]|2192.00||||2192.00|1972.8|1972.8|460.32
100079|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL +2.5MM OFFSET C TAPER 28MM HIP HIGH PERFORMANCE BIOLOX DELTA|GROUP PENSION ADMIN [1450]|GPA [145000]|2192.00||||2192.00|1534.4|1972.8|460.32
100079|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL +2.5MM OFFSET C TAPER 28MM HIP HIGH PERFORMANCE BIOLOX DELTA|FIRST HEALTH [1375]|QUALCHOICE [137513]|2192.00||||2192.00|1972.8|1972.8|460.32
100079|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL +2.5MM OFFSET C TAPER 28MM HIP HIGH PERFORMANCE BIOLOX DELTA|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|2192.00||||2192.00|1972.8|1972.8|460.32
100079|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL +2.5MM OFFSET C TAPER 28MM HIP HIGH PERFORMANCE BIOLOX DELTA|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|2192.00||||2192.00|1424.8|1972.8|460.32
100079|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL +2.5MM OFFSET C TAPER 28MM HIP HIGH PERFORMANCE BIOLOX DELTA|FIRST HEALTH [1375]|BENVEO/UCS [137512]|2192.00||||2192.00|1863.2|1972.8|460.32
100079|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL +2.5MM OFFSET C TAPER 28MM HIP HIGH PERFORMANCE BIOLOX DELTA|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|2192.00||||2192.00|1972.8|1972.8|460.32
100079|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL +2.5MM OFFSET C TAPER 28MM HIP HIGH PERFORMANCE BIOLOX DELTA|MULTIPLAN [1680]|HMA [168003]|2192.00||||2192.00|767.2|1972.8|460.32
100079|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL +2.5MM OFFSET C TAPER 28MM HIP HIGH PERFORMANCE BIOLOX DELTA|MULTIPLAN [1680]|IHC HS [168011]|2192.00||||2192.00|1972.8|1972.8|460.32
100079|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL +2.5MM OFFSET C TAPER 28MM HIP HIGH PERFORMANCE BIOLOX DELTA|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|2192.00||||2192.00|1972.8|1972.8|460.32
100079|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL +2.5MM OFFSET C TAPER 28MM HIP HIGH PERFORMANCE BIOLOX DELTA|AETNA [1015]|AMERICAN CONTINENTAL [101507]|2192.00||||2192.00|1534.4|1972.8|460.32
100079|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL +2.5MM OFFSET C TAPER 28MM HIP HIGH PERFORMANCE BIOLOX DELTA|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|2192.00||||2192.00|1972.8|1972.8|460.32
100079|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL +2.5MM OFFSET C TAPER 28MM HIP HIGH PERFORMANCE BIOLOX DELTA|AETNA [1015]|AETNA ACO WILCO [101532]|2192.00||||2192.00|767.2|1972.8|460.32
100079|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL +2.5MM OFFSET C TAPER 28MM HIP HIGH PERFORMANCE BIOLOX DELTA|AETNA [1015]|COVENTRY HEALTHCARE [101502]|2192.00||||2192.00|1972.8|1972.8|460.32
100079|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL +2.5MM OFFSET C TAPER 28MM HIP HIGH PERFORMANCE BIOLOX DELTA|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|2192.00||||2192.00|1078.46|1972.8|460.32
100079|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL +2.5MM OFFSET C TAPER 28MM HIP HIGH PERFORMANCE BIOLOX DELTA|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|2192.00||||2192.00|1269.17|1972.8|460.32
100079|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL +2.5MM OFFSET C TAPER 28MM HIP HIGH PERFORMANCE BIOLOX DELTA|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|2192.00||||2192.00|887.76|1972.8|460.32
100079|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL +2.5MM OFFSET C TAPER 28MM HIP HIGH PERFORMANCE BIOLOX DELTA|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|2192.00||||2192.00|1972.8|1972.8|460.32
100079|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL +2.5MM OFFSET C TAPER 28MM HIP HIGH PERFORMANCE BIOLOX DELTA|SAMBA HEALTH [2305]|SAMBA HEALTH [230500]|2192.00||||2192.00|1534.4|1972.8|460.32
100079|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL +2.5MM OFFSET C TAPER 28MM HIP HIGH PERFORMANCE BIOLOX DELTA|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|2192.00||||2192.00|942.56|1972.8|460.32
100079|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL +2.5MM OFFSET C TAPER 28MM HIP HIGH PERFORMANCE BIOLOX DELTA|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|2192.00||||2192.00|1972.8|1972.8|460.32
100079|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL +2.5MM OFFSET C TAPER 28MM HIP HIGH PERFORMANCE BIOLOX DELTA|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|2192.00||||2192.00|723.36|1972.8|460.32
100079|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL +2.5MM OFFSET C TAPER 28MM HIP HIGH PERFORMANCE BIOLOX DELTA|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|2192.00||||2192.00|460.32|1972.8|460.32
100079|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL +2.5MM OFFSET C TAPER 28MM HIP HIGH PERFORMANCE BIOLOX DELTA|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|2192.00||||2192.00|1096|1972.8|460.32
100079|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL +2.5MM OFFSET C TAPER 28MM HIP HIGH PERFORMANCE BIOLOX DELTA|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|2192.00||||2192.00|1972.8|1972.8|460.32
100079|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL +2.5MM OFFSET C TAPER 28MM HIP HIGH PERFORMANCE BIOLOX DELTA|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|2192.00||||2192.00|767.2|1972.8|460.32
100079|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL +2.5MM OFFSET C TAPER 28MM HIP HIGH PERFORMANCE BIOLOX DELTA|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|2192.00||||2192.00|1424.8|1972.8|460.32
100079|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL +2.5MM OFFSET C TAPER 28MM HIP HIGH PERFORMANCE BIOLOX DELTA|<Self-pay>|<Self-pay>|2192.00||||2192.00|657.6|1972.8|460.32
100079|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL +2.5MM OFFSET C TAPER 28MM HIP HIGH PERFORMANCE BIOLOX DELTA|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|2192.00||||2192.00|942.56|1972.8|460.32
100079|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL +2.5MM OFFSET C TAPER 28MM HIP HIGH PERFORMANCE BIOLOX DELTA|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|2192.00||||2192.00|1687.84|1972.8|460.32
100079|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL +2.5MM OFFSET C TAPER 28MM HIP HIGH PERFORMANCE BIOLOX DELTA|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|2192.00||||2192.00|1096|1972.8|460.32
100079|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL +2.5MM OFFSET C TAPER 28MM HIP HIGH PERFORMANCE BIOLOX DELTA|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|2192.00||||2192.00|1972.8|1972.8|460.32
100079|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL +2.5MM OFFSET C TAPER 28MM HIP HIGH PERFORMANCE BIOLOX DELTA|FMH BENEFIT SERVICES [1390]|FMH [139000]|2192.00||||2192.00|1972.8|1972.8|460.32
100079|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL +2.5MM OFFSET C TAPER 28MM HIP HIGH PERFORMANCE BIOLOX DELTA|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|2192.00||||2192.00|1972.8|1972.8|460.32
100079|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL +2.5MM OFFSET C TAPER 28MM HIP HIGH PERFORMANCE BIOLOX DELTA|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|2192.00||||2192.00|1972.8|1972.8|460.32
100079|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL +2.5MM OFFSET C TAPER 28MM HIP HIGH PERFORMANCE BIOLOX DELTA|HEALTHNET [1495]|HEALTHNET [149500]|2192.00||||2192.00|1972.8|1972.8|460.32
100079|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL +2.5MM OFFSET C TAPER 28MM HIP HIGH PERFORMANCE BIOLOX DELTA|CIGNA [1260]|CIGNA - GREAT WEST [126009]|2192.00||||2192.00|1534.4|1972.8|460.32
100079|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL +2.5MM OFFSET C TAPER 28MM HIP HIGH PERFORMANCE BIOLOX DELTA|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|2192.00||||2192.00|1972.8|1972.8|460.32
100079|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL +2.5MM OFFSET C TAPER 28MM HIP HIGH PERFORMANCE BIOLOX DELTA|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|2192.00||||2192.00|699.25|1972.8|460.32
100079|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL +2.5MM OFFSET C TAPER 28MM HIP HIGH PERFORMANCE BIOLOX DELTA|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|2192.00||||2192.00|1972.8|1972.8|460.32
100079|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL +2.5MM OFFSET C TAPER 28MM HIP HIGH PERFORMANCE BIOLOX DELTA|CORESOURCE [1315]|CORESOURCE [131500]|2192.00||||2192.00|1972.8|1972.8|460.32
100079|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL +2.5MM OFFSET C TAPER 28MM HIP HIGH PERFORMANCE BIOLOX DELTA|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|2192.00||||2192.00|767.2|1972.8|460.32
100079|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL +2.5MM OFFSET C TAPER 28MM HIP HIGH PERFORMANCE BIOLOX DELTA|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|2192.00||||2192.00|1424.8|1972.8|460.32
100079|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL +2.5MM OFFSET C TAPER 28MM HIP HIGH PERFORMANCE BIOLOX DELTA|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|2192.00||||2192.00|1972.8|1972.8|460.32
100079|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL +2.5MM OFFSET C TAPER 28MM HIP HIGH PERFORMANCE BIOLOX DELTA|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|2192.00||||2192.00|||
100079|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL +2.5MM OFFSET C TAPER 28MM HIP HIGH PERFORMANCE BIOLOX DELTA|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|2192.00||||2192.00|||
100079|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL +2.5MM OFFSET C TAPER 28MM HIP HIGH PERFORMANCE BIOLOX DELTA|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|2192.00||||2192.00|||
100079|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL +2.5MM OFFSET C TAPER 28MM HIP HIGH PERFORMANCE BIOLOX DELTA|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|2192.00||||2192.00|||
100079|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL +2.5MM OFFSET C TAPER 28MM HIP HIGH PERFORMANCE BIOLOX DELTA|GEHA [1415]|GEHA - ASA [141503]|2192.00||||2192.00|||
100079|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL +2.5MM OFFSET C TAPER 28MM HIP HIGH PERFORMANCE BIOLOX DELTA|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|2192.00||||2192.00|||
100079|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL +2.5MM OFFSET C TAPER 28MM HIP HIGH PERFORMANCE BIOLOX DELTA|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|2192.00||||2192.00|||
100079|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL +2.5MM OFFSET C TAPER 28MM HIP HIGH PERFORMANCE BIOLOX DELTA|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|2192.00||||2192.00|||
100079|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL +2.5MM OFFSET C TAPER 28MM HIP HIGH PERFORMANCE BIOLOX DELTA|CHAMPVA [1240]|CHAMP VA [124000]|2192.00||||2192.00|||
100079|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL +2.5MM OFFSET C TAPER 28MM HIP HIGH PERFORMANCE BIOLOX DELTA|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|2192.00||||2192.00|||
100079|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL +2.5MM OFFSET C TAPER 28MM HIP HIGH PERFORMANCE BIOLOX DELTA|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|2192.00||||2192.00|||
100079|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL +2.5MM OFFSET C TAPER 28MM HIP HIGH PERFORMANCE BIOLOX DELTA|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|2192.00||||2192.00|||
100079|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL +2.5MM OFFSET C TAPER 28MM HIP HIGH PERFORMANCE BIOLOX DELTA|UMR [2035]|UMR OPTIONS [203501]|2192.00||||2192.00|||
100079|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL +2.5MM OFFSET C TAPER 28MM HIP HIGH PERFORMANCE BIOLOX DELTA|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|2192.00||||2192.00|||
100079|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL +2.5MM OFFSET C TAPER 28MM HIP HIGH PERFORMANCE BIOLOX DELTA|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|2192.00||||2192.00|||
100079|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL +2.5MM OFFSET C TAPER 28MM HIP HIGH PERFORMANCE BIOLOX DELTA|UNITED HEALTHCARE [2060]|UHC MEDICA CHOICE [206030]|2192.00||||2192.00|||
100079|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL +2.5MM OFFSET C TAPER 28MM HIP HIGH PERFORMANCE BIOLOX DELTA|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|2192.00||||2192.00|||
100079|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL +2.5MM OFFSET C TAPER 28MM HIP HIGH PERFORMANCE BIOLOX DELTA|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|2192.00||||2192.00|||
100079|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL +2.5MM OFFSET C TAPER 28MM HIP HIGH PERFORMANCE BIOLOX DELTA|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|2192.00||||2192.00|||
100079|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL +2.5MM OFFSET C TAPER 28MM HIP HIGH PERFORMANCE BIOLOX DELTA|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|2192.00||||2192.00|||
100079|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL +2.5MM OFFSET C TAPER 28MM HIP HIGH PERFORMANCE BIOLOX DELTA|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|2192.00||||2192.00|||
100079|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL +2.5MM OFFSET C TAPER 28MM HIP HIGH PERFORMANCE BIOLOX DELTA|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|2192.00||||2192.00|||
100079|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL +2.5MM OFFSET C TAPER 28MM HIP HIGH PERFORMANCE BIOLOX DELTA|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|2192.00||||2192.00|||
100079|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL +2.5MM OFFSET C TAPER 28MM HIP HIGH PERFORMANCE BIOLOX DELTA|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|2192.00||||2192.00|||
100079|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL +2.5MM OFFSET C TAPER 28MM HIP HIGH PERFORMANCE BIOLOX DELTA|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|2192.00||||2192.00|||
100081|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL +0MM OFFSET C TAPER 32MM HIP HIGH PERFORMANCE BIOLOX DELTA|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|2192.00||||2192.00|1687.84|1972.8|460.32
100081|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL +0MM OFFSET C TAPER 32MM HIP HIGH PERFORMANCE BIOLOX DELTA|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|2192.00||||2192.00|1972.8|1972.8|460.32
100081|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL +0MM OFFSET C TAPER 32MM HIP HIGH PERFORMANCE BIOLOX DELTA|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|2192.00||||2192.00|1096|1972.8|460.32
100081|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL +0MM OFFSET C TAPER 32MM HIP HIGH PERFORMANCE BIOLOX DELTA|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|2192.00||||2192.00|460.32|1972.8|460.32
100081|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL +0MM OFFSET C TAPER 32MM HIP HIGH PERFORMANCE BIOLOX DELTA|FMH BENEFIT SERVICES [1390]|FMH [139000]|2192.00||||2192.00|1972.8|1972.8|460.32
100081|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL +0MM OFFSET C TAPER 32MM HIP HIGH PERFORMANCE BIOLOX DELTA|CIGNA [1260]|CIGNA - GREAT WEST [126009]|2192.00||||2192.00|1534.4|1972.8|460.32
100081|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL +0MM OFFSET C TAPER 32MM HIP HIGH PERFORMANCE BIOLOX DELTA|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|2192.00||||2192.00|1972.8|1972.8|460.32
100081|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL +0MM OFFSET C TAPER 32MM HIP HIGH PERFORMANCE BIOLOX DELTA|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|2192.00||||2192.00|1972.8|1972.8|460.32
100081|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL +0MM OFFSET C TAPER 32MM HIP HIGH PERFORMANCE BIOLOX DELTA|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|2192.00||||2192.00|699.25|1972.8|460.32
100081|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL +0MM OFFSET C TAPER 32MM HIP HIGH PERFORMANCE BIOLOX DELTA|CORESOURCE [1315]|CORESOURCE [131500]|2192.00||||2192.00|1972.8|1972.8|460.32
100081|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL +0MM OFFSET C TAPER 32MM HIP HIGH PERFORMANCE BIOLOX DELTA|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|2192.00||||2192.00|723.36|1972.8|460.32
100081|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL +0MM OFFSET C TAPER 32MM HIP HIGH PERFORMANCE BIOLOX DELTA|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|2192.00||||2192.00|1424.8|1972.8|460.32
100081|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL +0MM OFFSET C TAPER 32MM HIP HIGH PERFORMANCE BIOLOX DELTA|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|2192.00||||2192.00|1972.8|1972.8|460.32
100081|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL +0MM OFFSET C TAPER 32MM HIP HIGH PERFORMANCE BIOLOX DELTA|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|2192.00||||2192.00|1972.8|1972.8|460.32
100081|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL +0MM OFFSET C TAPER 32MM HIP HIGH PERFORMANCE BIOLOX DELTA|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|2192.00||||2192.00|1078.46|1972.8|460.32
100081|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL +0MM OFFSET C TAPER 32MM HIP HIGH PERFORMANCE BIOLOX DELTA|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|2192.00||||2192.00|942.56|1972.8|460.32
100081|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL +0MM OFFSET C TAPER 32MM HIP HIGH PERFORMANCE BIOLOX DELTA|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|2192.00||||2192.00|942.56|1972.8|460.32
100081|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL +0MM OFFSET C TAPER 32MM HIP HIGH PERFORMANCE BIOLOX DELTA|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|2192.00||||2192.00|767.2|1972.8|460.32
100081|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL +0MM OFFSET C TAPER 32MM HIP HIGH PERFORMANCE BIOLOX DELTA|AETNA [1015]|COVENTRY HEALTHCARE [101502]|2192.00||||2192.00|1972.8|1972.8|460.32
100081|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL +0MM OFFSET C TAPER 32MM HIP HIGH PERFORMANCE BIOLOX DELTA|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|2192.00||||2192.00|1096|1972.8|460.32
100081|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL +0MM OFFSET C TAPER 32MM HIP HIGH PERFORMANCE BIOLOX DELTA|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|2192.00||||2192.00|1972.8|1972.8|460.32
100081|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL +0MM OFFSET C TAPER 32MM HIP HIGH PERFORMANCE BIOLOX DELTA|AETNA [1015]|AMERICAN CONTINENTAL [101507]|2192.00||||2192.00|1534.4|1972.8|460.32
100081|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL +0MM OFFSET C TAPER 32MM HIP HIGH PERFORMANCE BIOLOX DELTA|MULTIPLAN [1680]|IHC HS [168011]|2192.00||||2192.00|1972.8|1972.8|460.32
100081|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL +0MM OFFSET C TAPER 32MM HIP HIGH PERFORMANCE BIOLOX DELTA|MULTIPLAN [1680]|HMA [168003]|2192.00||||2192.00|767.2|1972.8|460.32
100081|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL +0MM OFFSET C TAPER 32MM HIP HIGH PERFORMANCE BIOLOX DELTA|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|2192.00||||2192.00|1972.8|1972.8|460.32
100081|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL +0MM OFFSET C TAPER 32MM HIP HIGH PERFORMANCE BIOLOX DELTA|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|2192.00||||2192.00|767.2|1972.8|460.32
100081|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL +0MM OFFSET C TAPER 32MM HIP HIGH PERFORMANCE BIOLOX DELTA|HEALTHNET [1495]|HEALTHNET [149500]|2192.00||||2192.00|1972.8|1972.8|460.32
100081|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL +0MM OFFSET C TAPER 32MM HIP HIGH PERFORMANCE BIOLOX DELTA|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|2192.00||||2192.00|1424.8|1972.8|460.32
100081|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL +0MM OFFSET C TAPER 32MM HIP HIGH PERFORMANCE BIOLOX DELTA|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|2192.00||||2192.00|1972.8|1972.8|460.32
100081|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL +0MM OFFSET C TAPER 32MM HIP HIGH PERFORMANCE BIOLOX DELTA|<Self-pay>|<Self-pay>|2192.00||||2192.00|657.6|1972.8|460.32
100081|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL +0MM OFFSET C TAPER 32MM HIP HIGH PERFORMANCE BIOLOX DELTA|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|2192.00||||2192.00|1972.8|1972.8|460.32
100081|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL +0MM OFFSET C TAPER 32MM HIP HIGH PERFORMANCE BIOLOX DELTA|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|2192.00||||2192.00|1424.8|1972.8|460.32
100081|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL +0MM OFFSET C TAPER 32MM HIP HIGH PERFORMANCE BIOLOX DELTA|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|2192.00||||2192.00|1972.8|1972.8|460.32
100081|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL +0MM OFFSET C TAPER 32MM HIP HIGH PERFORMANCE BIOLOX DELTA|FIRST HEALTH [1375]|QUALCHOICE [137513]|2192.00||||2192.00|1972.8|1972.8|460.32
100081|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL +0MM OFFSET C TAPER 32MM HIP HIGH PERFORMANCE BIOLOX DELTA|FIRST HEALTH [1375]|BENVEO/UCS [137512]|2192.00||||2192.00|1863.2|1972.8|460.32
100081|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL +0MM OFFSET C TAPER 32MM HIP HIGH PERFORMANCE BIOLOX DELTA|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|2192.00||||2192.00|1972.8|1972.8|460.32
100081|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL +0MM OFFSET C TAPER 32MM HIP HIGH PERFORMANCE BIOLOX DELTA|AETNA [1015]|AETNA ACO WILCO [101532]|2192.00||||2192.00|767.2|1972.8|460.32
100081|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL +0MM OFFSET C TAPER 32MM HIP HIGH PERFORMANCE BIOLOX DELTA|GROUP PENSION ADMIN [1450]|GPA [145000]|2192.00||||2192.00|1534.4|1972.8|460.32
100081|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL +0MM OFFSET C TAPER 32MM HIP HIGH PERFORMANCE BIOLOX DELTA|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|2192.00||||2192.00|887.76|1972.8|460.32
100081|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL +0MM OFFSET C TAPER 32MM HIP HIGH PERFORMANCE BIOLOX DELTA|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|2192.00||||2192.00|1972.8|1972.8|460.32
100081|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL +0MM OFFSET C TAPER 32MM HIP HIGH PERFORMANCE BIOLOX DELTA|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|2192.00||||2192.00|1269.17|1972.8|460.32
100081|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL +0MM OFFSET C TAPER 32MM HIP HIGH PERFORMANCE BIOLOX DELTA|TRUSTMARK [2030]|STARMARK [203000]|2192.00||||2192.00|1972.8|1972.8|460.32
100081|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL +0MM OFFSET C TAPER 32MM HIP HIGH PERFORMANCE BIOLOX DELTA|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|2192.00||||2192.00|1972.8|1972.8|460.32
100081|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL +0MM OFFSET C TAPER 32MM HIP HIGH PERFORMANCE BIOLOX DELTA|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|2192.00||||2192.00|1972.8|1972.8|460.32
100081|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL +0MM OFFSET C TAPER 32MM HIP HIGH PERFORMANCE BIOLOX DELTA|SAMBA HEALTH [2305]|SAMBA HEALTH [230500]|2192.00||||2192.00|1534.4|1972.8|460.32
100081|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL +0MM OFFSET C TAPER 32MM HIP HIGH PERFORMANCE BIOLOX DELTA|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|2192.00||||2192.00|1972.8|1972.8|460.32
100081|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL +0MM OFFSET C TAPER 32MM HIP HIGH PERFORMANCE BIOLOX DELTA|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|2192.00||||2192.00|||
100081|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL +0MM OFFSET C TAPER 32MM HIP HIGH PERFORMANCE BIOLOX DELTA|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|2192.00||||2192.00|||
100081|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL +0MM OFFSET C TAPER 32MM HIP HIGH PERFORMANCE BIOLOX DELTA|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|2192.00||||2192.00|||
100081|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL +0MM OFFSET C TAPER 32MM HIP HIGH PERFORMANCE BIOLOX DELTA|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|2192.00||||2192.00|||
100081|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL +0MM OFFSET C TAPER 32MM HIP HIGH PERFORMANCE BIOLOX DELTA|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|2192.00||||2192.00|||
100081|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL +0MM OFFSET C TAPER 32MM HIP HIGH PERFORMANCE BIOLOX DELTA|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|2192.00||||2192.00|||
100081|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL +0MM OFFSET C TAPER 32MM HIP HIGH PERFORMANCE BIOLOX DELTA|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|2192.00||||2192.00|||
100081|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL +0MM OFFSET C TAPER 32MM HIP HIGH PERFORMANCE BIOLOX DELTA|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|2192.00||||2192.00|||
100081|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL +0MM OFFSET C TAPER 32MM HIP HIGH PERFORMANCE BIOLOX DELTA|CHAMPVA [1240]|CHAMP VA [124000]|2192.00||||2192.00|||
100081|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL +0MM OFFSET C TAPER 32MM HIP HIGH PERFORMANCE BIOLOX DELTA|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|2192.00||||2192.00|||
100081|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL +0MM OFFSET C TAPER 32MM HIP HIGH PERFORMANCE BIOLOX DELTA|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|2192.00||||2192.00|||
100081|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL +0MM OFFSET C TAPER 32MM HIP HIGH PERFORMANCE BIOLOX DELTA|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|2192.00||||2192.00|||
100081|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL +0MM OFFSET C TAPER 32MM HIP HIGH PERFORMANCE BIOLOX DELTA|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|2192.00||||2192.00|||
100081|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL +0MM OFFSET C TAPER 32MM HIP HIGH PERFORMANCE BIOLOX DELTA|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|2192.00||||2192.00|||
100081|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL +0MM OFFSET C TAPER 32MM HIP HIGH PERFORMANCE BIOLOX DELTA|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|2192.00||||2192.00|||
100081|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL +0MM OFFSET C TAPER 32MM HIP HIGH PERFORMANCE BIOLOX DELTA|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|2192.00||||2192.00|||
100081|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL +0MM OFFSET C TAPER 32MM HIP HIGH PERFORMANCE BIOLOX DELTA|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|2192.00||||2192.00|||
100081|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL +0MM OFFSET C TAPER 32MM HIP HIGH PERFORMANCE BIOLOX DELTA|GEHA [1415]|GEHA - ASA [141503]|2192.00||||2192.00|||
100081|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL +0MM OFFSET C TAPER 32MM HIP HIGH PERFORMANCE BIOLOX DELTA|UNITED HEALTHCARE [2060]|UHC MEDICA CHOICE [206030]|2192.00||||2192.00|||
100081|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL +0MM OFFSET C TAPER 32MM HIP HIGH PERFORMANCE BIOLOX DELTA|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|2192.00||||2192.00|||
100081|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL +0MM OFFSET C TAPER 32MM HIP HIGH PERFORMANCE BIOLOX DELTA|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|2192.00||||2192.00|||
100081|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL +0MM OFFSET C TAPER 32MM HIP HIGH PERFORMANCE BIOLOX DELTA|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|2192.00||||2192.00|||
100081|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL +0MM OFFSET C TAPER 32MM HIP HIGH PERFORMANCE BIOLOX DELTA|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|2192.00||||2192.00|||
100081|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL +0MM OFFSET C TAPER 32MM HIP HIGH PERFORMANCE BIOLOX DELTA|UMR [2035]|UMR OPTIONS [203501]|2192.00||||2192.00|||
100081|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL +0MM OFFSET C TAPER 32MM HIP HIGH PERFORMANCE BIOLOX DELTA|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|2192.00||||2192.00|||
100084|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL -2.5MM OFFSET C TAPER 32MM HIP HIGH PERFORMANCE BIOLOX DELTA|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|2192.00||||2192.00|1972.8|1972.8|460.32
100084|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL -2.5MM OFFSET C TAPER 32MM HIP HIGH PERFORMANCE BIOLOX DELTA|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|2192.00||||2192.00|1972.8|1972.8|460.32
100084|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL -2.5MM OFFSET C TAPER 32MM HIP HIGH PERFORMANCE BIOLOX DELTA|TRUSTMARK [2030]|STARMARK [203000]|2192.00||||2192.00|1972.8|1972.8|460.32
100084|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL -2.5MM OFFSET C TAPER 32MM HIP HIGH PERFORMANCE BIOLOX DELTA|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|2192.00||||2192.00|1972.8|1972.8|460.32
100084|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL -2.5MM OFFSET C TAPER 32MM HIP HIGH PERFORMANCE BIOLOX DELTA|GROUP PENSION ADMIN [1450]|GPA [145000]|2192.00||||2192.00|1534.4|1972.8|460.32
100084|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL -2.5MM OFFSET C TAPER 32MM HIP HIGH PERFORMANCE BIOLOX DELTA|FIRST HEALTH [1375]|QUALCHOICE [137513]|2192.00||||2192.00|1972.8|1972.8|460.32
100084|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL -2.5MM OFFSET C TAPER 32MM HIP HIGH PERFORMANCE BIOLOX DELTA|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|2192.00||||2192.00|1972.8|1972.8|460.32
100084|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL -2.5MM OFFSET C TAPER 32MM HIP HIGH PERFORMANCE BIOLOX DELTA|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|2192.00||||2192.00|1424.8|1972.8|460.32
100084|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL -2.5MM OFFSET C TAPER 32MM HIP HIGH PERFORMANCE BIOLOX DELTA|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|2192.00||||2192.00|1424.8|1972.8|460.32
100084|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL -2.5MM OFFSET C TAPER 32MM HIP HIGH PERFORMANCE BIOLOX DELTA|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|2192.00||||2192.00|1972.8|1972.8|460.32
100084|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL -2.5MM OFFSET C TAPER 32MM HIP HIGH PERFORMANCE BIOLOX DELTA|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|2192.00||||2192.00|767.2|1972.8|460.32
100084|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL -2.5MM OFFSET C TAPER 32MM HIP HIGH PERFORMANCE BIOLOX DELTA|MULTIPLAN [1680]|HMA [168003]|2192.00||||2192.00|767.2|1972.8|460.32
100084|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL -2.5MM OFFSET C TAPER 32MM HIP HIGH PERFORMANCE BIOLOX DELTA|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|2192.00||||2192.00|1972.8|1972.8|460.32
100084|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL -2.5MM OFFSET C TAPER 32MM HIP HIGH PERFORMANCE BIOLOX DELTA|FIRST HEALTH [1375]|BENVEO/UCS [137512]|2192.00||||2192.00|1863.2|1972.8|460.32
100084|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL -2.5MM OFFSET C TAPER 32MM HIP HIGH PERFORMANCE BIOLOX DELTA|AETNA [1015]|COVENTRY HEALTHCARE [101502]|2192.00||||2192.00|1972.8|1972.8|460.32
100084|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL -2.5MM OFFSET C TAPER 32MM HIP HIGH PERFORMANCE BIOLOX DELTA|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|2192.00||||2192.00|1972.8|1972.8|460.32
100084|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL -2.5MM OFFSET C TAPER 32MM HIP HIGH PERFORMANCE BIOLOX DELTA|AETNA [1015]|AETNA ACO WILCO [101532]|2192.00||||2192.00|767.2|1972.8|460.32
100084|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL -2.5MM OFFSET C TAPER 32MM HIP HIGH PERFORMANCE BIOLOX DELTA|AETNA [1015]|AMERICAN CONTINENTAL [101507]|2192.00||||2192.00|1534.4|1972.8|460.32
100084|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL -2.5MM OFFSET C TAPER 32MM HIP HIGH PERFORMANCE BIOLOX DELTA|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|2192.00||||2192.00|1269.17|1972.8|460.32
100084|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL -2.5MM OFFSET C TAPER 32MM HIP HIGH PERFORMANCE BIOLOX DELTA|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|2192.00||||2192.00|1078.46|1972.8|460.32
100084|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL -2.5MM OFFSET C TAPER 32MM HIP HIGH PERFORMANCE BIOLOX DELTA|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|2192.00||||2192.00|887.76|1972.8|460.32
100084|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL -2.5MM OFFSET C TAPER 32MM HIP HIGH PERFORMANCE BIOLOX DELTA|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|2192.00||||2192.00|942.56|1972.8|460.32
100084|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL -2.5MM OFFSET C TAPER 32MM HIP HIGH PERFORMANCE BIOLOX DELTA|SAMBA HEALTH [2305]|SAMBA HEALTH [230500]|2192.00||||2192.00|1534.4|1972.8|460.32
100084|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL -2.5MM OFFSET C TAPER 32MM HIP HIGH PERFORMANCE BIOLOX DELTA|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|2192.00||||2192.00|1972.8|1972.8|460.32
100084|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL -2.5MM OFFSET C TAPER 32MM HIP HIGH PERFORMANCE BIOLOX DELTA|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|2192.00||||2192.00|767.2|1972.8|460.32
100084|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL -2.5MM OFFSET C TAPER 32MM HIP HIGH PERFORMANCE BIOLOX DELTA|CORESOURCE [1315]|CORESOURCE [131500]|2192.00||||2192.00|1972.8|1972.8|460.32
100084|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL -2.5MM OFFSET C TAPER 32MM HIP HIGH PERFORMANCE BIOLOX DELTA|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|2192.00||||2192.00|1972.8|1972.8|460.32
100084|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL -2.5MM OFFSET C TAPER 32MM HIP HIGH PERFORMANCE BIOLOX DELTA|MULTIPLAN [1680]|IHC HS [168011]|2192.00||||2192.00|1972.8|1972.8|460.32
100084|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL -2.5MM OFFSET C TAPER 32MM HIP HIGH PERFORMANCE BIOLOX DELTA|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|2192.00||||2192.00|1972.8|1972.8|460.32
100084|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL -2.5MM OFFSET C TAPER 32MM HIP HIGH PERFORMANCE BIOLOX DELTA|<Self-pay>|<Self-pay>|2192.00||||2192.00|657.6|1972.8|460.32
100084|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL -2.5MM OFFSET C TAPER 32MM HIP HIGH PERFORMANCE BIOLOX DELTA|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|2192.00||||2192.00|699.25|1972.8|460.32
100084|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL -2.5MM OFFSET C TAPER 32MM HIP HIGH PERFORMANCE BIOLOX DELTA|HEALTHNET [1495]|HEALTHNET [149500]|2192.00||||2192.00|1972.8|1972.8|460.32
100084|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL -2.5MM OFFSET C TAPER 32MM HIP HIGH PERFORMANCE BIOLOX DELTA|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|2192.00||||2192.00|1972.8|1972.8|460.32
100084|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL -2.5MM OFFSET C TAPER 32MM HIP HIGH PERFORMANCE BIOLOX DELTA|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|2192.00||||2192.00|1972.8|1972.8|460.32
100084|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL -2.5MM OFFSET C TAPER 32MM HIP HIGH PERFORMANCE BIOLOX DELTA|CIGNA [1260]|CIGNA - GREAT WEST [126009]|2192.00||||2192.00|1534.4|1972.8|460.32
100084|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL -2.5MM OFFSET C TAPER 32MM HIP HIGH PERFORMANCE BIOLOX DELTA|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|2192.00||||2192.00|1972.8|1972.8|460.32
100084|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL -2.5MM OFFSET C TAPER 32MM HIP HIGH PERFORMANCE BIOLOX DELTA|FMH BENEFIT SERVICES [1390]|FMH [139000]|2192.00||||2192.00|1972.8|1972.8|460.32
100084|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL -2.5MM OFFSET C TAPER 32MM HIP HIGH PERFORMANCE BIOLOX DELTA|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|2192.00||||2192.00|723.36|1972.8|460.32
100084|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL -2.5MM OFFSET C TAPER 32MM HIP HIGH PERFORMANCE BIOLOX DELTA|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|2192.00||||2192.00|460.32|1972.8|460.32
100084|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL -2.5MM OFFSET C TAPER 32MM HIP HIGH PERFORMANCE BIOLOX DELTA|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|2192.00||||2192.00|1096|1972.8|460.32
100084|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL -2.5MM OFFSET C TAPER 32MM HIP HIGH PERFORMANCE BIOLOX DELTA|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|2192.00||||2192.00|1424.8|1972.8|460.32
100084|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL -2.5MM OFFSET C TAPER 32MM HIP HIGH PERFORMANCE BIOLOX DELTA|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|2192.00||||2192.00|1972.8|1972.8|460.32
100084|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL -2.5MM OFFSET C TAPER 32MM HIP HIGH PERFORMANCE BIOLOX DELTA|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|2192.00||||2192.00|1096|1972.8|460.32
100084|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL -2.5MM OFFSET C TAPER 32MM HIP HIGH PERFORMANCE BIOLOX DELTA|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|2192.00||||2192.00|1972.8|1972.8|460.32
100084|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL -2.5MM OFFSET C TAPER 32MM HIP HIGH PERFORMANCE BIOLOX DELTA|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|2192.00||||2192.00|1687.84|1972.8|460.32
100084|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL -2.5MM OFFSET C TAPER 32MM HIP HIGH PERFORMANCE BIOLOX DELTA|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|2192.00||||2192.00|942.56|1972.8|460.32
100084|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL -2.5MM OFFSET C TAPER 32MM HIP HIGH PERFORMANCE BIOLOX DELTA|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|2192.00||||2192.00|||
100084|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL -2.5MM OFFSET C TAPER 32MM HIP HIGH PERFORMANCE BIOLOX DELTA|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|2192.00||||2192.00|||
100084|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL -2.5MM OFFSET C TAPER 32MM HIP HIGH PERFORMANCE BIOLOX DELTA|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|2192.00||||2192.00|||
100084|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL -2.5MM OFFSET C TAPER 32MM HIP HIGH PERFORMANCE BIOLOX DELTA|GEHA [1415]|GEHA - ASA [141503]|2192.00||||2192.00|||
100084|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL -2.5MM OFFSET C TAPER 32MM HIP HIGH PERFORMANCE BIOLOX DELTA|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|2192.00||||2192.00|||
100084|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL -2.5MM OFFSET C TAPER 32MM HIP HIGH PERFORMANCE BIOLOX DELTA|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|2192.00||||2192.00|||
100084|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL -2.5MM OFFSET C TAPER 32MM HIP HIGH PERFORMANCE BIOLOX DELTA|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|2192.00||||2192.00|||
100084|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL -2.5MM OFFSET C TAPER 32MM HIP HIGH PERFORMANCE BIOLOX DELTA|UMR [2035]|UMR OPTIONS [203501]|2192.00||||2192.00|||
100084|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL -2.5MM OFFSET C TAPER 32MM HIP HIGH PERFORMANCE BIOLOX DELTA|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|2192.00||||2192.00|||
100084|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL -2.5MM OFFSET C TAPER 32MM HIP HIGH PERFORMANCE BIOLOX DELTA|CHAMPVA [1240]|CHAMP VA [124000]|2192.00||||2192.00|||
100084|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL -2.5MM OFFSET C TAPER 32MM HIP HIGH PERFORMANCE BIOLOX DELTA|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|2192.00||||2192.00|||
100084|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL -2.5MM OFFSET C TAPER 32MM HIP HIGH PERFORMANCE BIOLOX DELTA|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|2192.00||||2192.00|||
100084|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL -2.5MM OFFSET C TAPER 32MM HIP HIGH PERFORMANCE BIOLOX DELTA|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|2192.00||||2192.00|||
100084|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL -2.5MM OFFSET C TAPER 32MM HIP HIGH PERFORMANCE BIOLOX DELTA|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|2192.00||||2192.00|||
100084|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL -2.5MM OFFSET C TAPER 32MM HIP HIGH PERFORMANCE BIOLOX DELTA|UNITED HEALTHCARE [2060]|UHC MEDICA CHOICE [206030]|2192.00||||2192.00|||
100084|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL -2.5MM OFFSET C TAPER 32MM HIP HIGH PERFORMANCE BIOLOX DELTA|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|2192.00||||2192.00|||
100084|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL -2.5MM OFFSET C TAPER 32MM HIP HIGH PERFORMANCE BIOLOX DELTA|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|2192.00||||2192.00|||
100084|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL -2.5MM OFFSET C TAPER 32MM HIP HIGH PERFORMANCE BIOLOX DELTA|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|2192.00||||2192.00|||
100084|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL -2.5MM OFFSET C TAPER 32MM HIP HIGH PERFORMANCE BIOLOX DELTA|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|2192.00||||2192.00|||
100084|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL -2.5MM OFFSET C TAPER 32MM HIP HIGH PERFORMANCE BIOLOX DELTA|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|2192.00||||2192.00|||
100084|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL -2.5MM OFFSET C TAPER 32MM HIP HIGH PERFORMANCE BIOLOX DELTA|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|2192.00||||2192.00|||
100084|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL -2.5MM OFFSET C TAPER 32MM HIP HIGH PERFORMANCE BIOLOX DELTA|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|2192.00||||2192.00|||
100084|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL -2.5MM OFFSET C TAPER 32MM HIP HIGH PERFORMANCE BIOLOX DELTA|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|2192.00||||2192.00|||
100084|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL -2.5MM OFFSET C TAPER 32MM HIP HIGH PERFORMANCE BIOLOX DELTA|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|2192.00||||2192.00|||
100084|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL -2.5MM OFFSET C TAPER 32MM HIP HIGH PERFORMANCE BIOLOX DELTA|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|2192.00||||2192.00|||
100085|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL 0MM OFFSET C TAPER 36MM HIP HIGH PERFORMANCE BIOLOX DELTA|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|2192.00||||2192.00|1687.84|1972.8|460.32
100085|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL 0MM OFFSET C TAPER 36MM HIP HIGH PERFORMANCE BIOLOX DELTA|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|2192.00||||2192.00|942.56|1972.8|460.32
100085|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL 0MM OFFSET C TAPER 36MM HIP HIGH PERFORMANCE BIOLOX DELTA|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|2192.00||||2192.00|1972.8|1972.8|460.32
100085|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL 0MM OFFSET C TAPER 36MM HIP HIGH PERFORMANCE BIOLOX DELTA|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|2192.00||||2192.00|1972.8|1972.8|460.32
100085|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL 0MM OFFSET C TAPER 36MM HIP HIGH PERFORMANCE BIOLOX DELTA|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|2192.00||||2192.00|723.36|1972.8|460.32
100085|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL 0MM OFFSET C TAPER 36MM HIP HIGH PERFORMANCE BIOLOX DELTA|CIGNA [1260]|CIGNA - GREAT WEST [126009]|2192.00||||2192.00|1534.4|1972.8|460.32
100085|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL 0MM OFFSET C TAPER 36MM HIP HIGH PERFORMANCE BIOLOX DELTA|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|2192.00||||2192.00|1972.8|1972.8|460.32
100085|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL 0MM OFFSET C TAPER 36MM HIP HIGH PERFORMANCE BIOLOX DELTA|HEALTHNET [1495]|HEALTHNET [149500]|2192.00||||2192.00|1972.8|1972.8|460.32
100085|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL 0MM OFFSET C TAPER 36MM HIP HIGH PERFORMANCE BIOLOX DELTA|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|2192.00||||2192.00|699.25|1972.8|460.32
100085|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL 0MM OFFSET C TAPER 36MM HIP HIGH PERFORMANCE BIOLOX DELTA|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|2192.00||||2192.00|1972.8|1972.8|460.32
100085|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL 0MM OFFSET C TAPER 36MM HIP HIGH PERFORMANCE BIOLOX DELTA|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|2192.00||||2192.00|1096|1972.8|460.32
100085|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL 0MM OFFSET C TAPER 36MM HIP HIGH PERFORMANCE BIOLOX DELTA|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|2192.00||||2192.00|1096|1972.8|460.32
100085|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL 0MM OFFSET C TAPER 36MM HIP HIGH PERFORMANCE BIOLOX DELTA|CORESOURCE [1315]|CORESOURCE [131500]|2192.00||||2192.00|1972.8|1972.8|460.32
100085|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL 0MM OFFSET C TAPER 36MM HIP HIGH PERFORMANCE BIOLOX DELTA|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|2192.00||||2192.00|1424.8|1972.8|460.32
100085|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL 0MM OFFSET C TAPER 36MM HIP HIGH PERFORMANCE BIOLOX DELTA|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|2192.00||||2192.00|1972.8|1972.8|460.32
100085|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL 0MM OFFSET C TAPER 36MM HIP HIGH PERFORMANCE BIOLOX DELTA|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|2192.00||||2192.00|942.56|1972.8|460.32
100085|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL 0MM OFFSET C TAPER 36MM HIP HIGH PERFORMANCE BIOLOX DELTA|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|2192.00||||2192.00|887.76|1972.8|460.32
100085|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL 0MM OFFSET C TAPER 36MM HIP HIGH PERFORMANCE BIOLOX DELTA|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|2192.00||||2192.00|1972.8|1972.8|460.32
100085|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL 0MM OFFSET C TAPER 36MM HIP HIGH PERFORMANCE BIOLOX DELTA|AETNA [1015]|AMERICAN CONTINENTAL [101507]|2192.00||||2192.00|1534.4|1972.8|460.32
100085|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL 0MM OFFSET C TAPER 36MM HIP HIGH PERFORMANCE BIOLOX DELTA|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|2192.00||||2192.00|1972.8|1972.8|460.32
100085|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL 0MM OFFSET C TAPER 36MM HIP HIGH PERFORMANCE BIOLOX DELTA|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|2192.00||||2192.00|767.2|1972.8|460.32
100085|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL 0MM OFFSET C TAPER 36MM HIP HIGH PERFORMANCE BIOLOX DELTA|MULTIPLAN [1680]|IHC HS [168011]|2192.00||||2192.00|1972.8|1972.8|460.32
100085|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL 0MM OFFSET C TAPER 36MM HIP HIGH PERFORMANCE BIOLOX DELTA|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|2192.00||||2192.00|1972.8|1972.8|460.32
100085|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL 0MM OFFSET C TAPER 36MM HIP HIGH PERFORMANCE BIOLOX DELTA|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|2192.00||||2192.00|1972.8|1972.8|460.32
100085|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL 0MM OFFSET C TAPER 36MM HIP HIGH PERFORMANCE BIOLOX DELTA|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|2192.00||||2192.00|1424.8|1972.8|460.32
100085|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL 0MM OFFSET C TAPER 36MM HIP HIGH PERFORMANCE BIOLOX DELTA|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|2192.00||||2192.00|1972.8|1972.8|460.32
100085|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL 0MM OFFSET C TAPER 36MM HIP HIGH PERFORMANCE BIOLOX DELTA|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|2192.00||||2192.00|1424.8|1972.8|460.32
100085|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL 0MM OFFSET C TAPER 36MM HIP HIGH PERFORMANCE BIOLOX DELTA|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|2192.00||||2192.00|460.32|1972.8|460.32
100085|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL 0MM OFFSET C TAPER 36MM HIP HIGH PERFORMANCE BIOLOX DELTA|FMH BENEFIT SERVICES [1390]|FMH [139000]|2192.00||||2192.00|1972.8|1972.8|460.32
100085|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL 0MM OFFSET C TAPER 36MM HIP HIGH PERFORMANCE BIOLOX DELTA|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|2192.00||||2192.00|1972.8|1972.8|460.32
100085|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL 0MM OFFSET C TAPER 36MM HIP HIGH PERFORMANCE BIOLOX DELTA|<Self-pay>|<Self-pay>|2192.00||||2192.00|657.6|1972.8|460.32
100085|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL 0MM OFFSET C TAPER 36MM HIP HIGH PERFORMANCE BIOLOX DELTA|FIRST HEALTH [1375]|BENVEO/UCS [137512]|2192.00||||2192.00|1863.2|1972.8|460.32
100085|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL 0MM OFFSET C TAPER 36MM HIP HIGH PERFORMANCE BIOLOX DELTA|MULTIPLAN [1680]|HMA [168003]|2192.00||||2192.00|767.2|1972.8|460.32
100085|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL 0MM OFFSET C TAPER 36MM HIP HIGH PERFORMANCE BIOLOX DELTA|FIRST HEALTH [1375]|QUALCHOICE [137513]|2192.00||||2192.00|1972.8|1972.8|460.32
100085|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL 0MM OFFSET C TAPER 36MM HIP HIGH PERFORMANCE BIOLOX DELTA|GROUP PENSION ADMIN [1450]|GPA [145000]|2192.00||||2192.00|1534.4|1972.8|460.32
100085|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL 0MM OFFSET C TAPER 36MM HIP HIGH PERFORMANCE BIOLOX DELTA|AETNA [1015]|COVENTRY HEALTHCARE [101502]|2192.00||||2192.00|1972.8|1972.8|460.32
100085|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL 0MM OFFSET C TAPER 36MM HIP HIGH PERFORMANCE BIOLOX DELTA|AETNA [1015]|AETNA ACO WILCO [101532]|2192.00||||2192.00|767.2|1972.8|460.32
100085|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL 0MM OFFSET C TAPER 36MM HIP HIGH PERFORMANCE BIOLOX DELTA|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|2192.00||||2192.00|1972.8|1972.8|460.32
100085|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL 0MM OFFSET C TAPER 36MM HIP HIGH PERFORMANCE BIOLOX DELTA|TRUSTMARK [2030]|STARMARK [203000]|2192.00||||2192.00|1972.8|1972.8|460.32
100085|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL 0MM OFFSET C TAPER 36MM HIP HIGH PERFORMANCE BIOLOX DELTA|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|2192.00||||2192.00|1269.17|1972.8|460.32
100085|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL 0MM OFFSET C TAPER 36MM HIP HIGH PERFORMANCE BIOLOX DELTA|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|2192.00||||2192.00|1972.8|1972.8|460.32
100085|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL 0MM OFFSET C TAPER 36MM HIP HIGH PERFORMANCE BIOLOX DELTA|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|2192.00||||2192.00|767.2|1972.8|460.32
100085|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL 0MM OFFSET C TAPER 36MM HIP HIGH PERFORMANCE BIOLOX DELTA|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|2192.00||||2192.00|1972.8|1972.8|460.32
100085|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL 0MM OFFSET C TAPER 36MM HIP HIGH PERFORMANCE BIOLOX DELTA|SAMBA HEALTH [2305]|SAMBA HEALTH [230500]|2192.00||||2192.00|1534.4|1972.8|460.32
100085|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL 0MM OFFSET C TAPER 36MM HIP HIGH PERFORMANCE BIOLOX DELTA|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|2192.00||||2192.00|1972.8|1972.8|460.32
100085|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL 0MM OFFSET C TAPER 36MM HIP HIGH PERFORMANCE BIOLOX DELTA|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|2192.00||||2192.00|1078.46|1972.8|460.32
100085|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL 0MM OFFSET C TAPER 36MM HIP HIGH PERFORMANCE BIOLOX DELTA|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|2192.00||||2192.00|||
100085|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL 0MM OFFSET C TAPER 36MM HIP HIGH PERFORMANCE BIOLOX DELTA|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|2192.00||||2192.00|||
100085|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL 0MM OFFSET C TAPER 36MM HIP HIGH PERFORMANCE BIOLOX DELTA|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|2192.00||||2192.00|||
100085|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL 0MM OFFSET C TAPER 36MM HIP HIGH PERFORMANCE BIOLOX DELTA|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|2192.00||||2192.00|||
100085|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL 0MM OFFSET C TAPER 36MM HIP HIGH PERFORMANCE BIOLOX DELTA|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|2192.00||||2192.00|||
100085|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL 0MM OFFSET C TAPER 36MM HIP HIGH PERFORMANCE BIOLOX DELTA|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|2192.00||||2192.00|||
100085|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL 0MM OFFSET C TAPER 36MM HIP HIGH PERFORMANCE BIOLOX DELTA|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|2192.00||||2192.00|||
100085|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL 0MM OFFSET C TAPER 36MM HIP HIGH PERFORMANCE BIOLOX DELTA|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|2192.00||||2192.00|||
100085|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL 0MM OFFSET C TAPER 36MM HIP HIGH PERFORMANCE BIOLOX DELTA|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|2192.00||||2192.00|||
100085|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL 0MM OFFSET C TAPER 36MM HIP HIGH PERFORMANCE BIOLOX DELTA|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|2192.00||||2192.00|||
100085|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL 0MM OFFSET C TAPER 36MM HIP HIGH PERFORMANCE BIOLOX DELTA|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|2192.00||||2192.00|||
100085|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL 0MM OFFSET C TAPER 36MM HIP HIGH PERFORMANCE BIOLOX DELTA|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|2192.00||||2192.00|||
100085|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL 0MM OFFSET C TAPER 36MM HIP HIGH PERFORMANCE BIOLOX DELTA|CHAMPVA [1240]|CHAMP VA [124000]|2192.00||||2192.00|||
100085|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL 0MM OFFSET C TAPER 36MM HIP HIGH PERFORMANCE BIOLOX DELTA|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|2192.00||||2192.00|||
100085|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL 0MM OFFSET C TAPER 36MM HIP HIGH PERFORMANCE BIOLOX DELTA|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|2192.00||||2192.00|||
100085|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL 0MM OFFSET C TAPER 36MM HIP HIGH PERFORMANCE BIOLOX DELTA|GEHA [1415]|GEHA - ASA [141503]|2192.00||||2192.00|||
100085|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL 0MM OFFSET C TAPER 36MM HIP HIGH PERFORMANCE BIOLOX DELTA|UNITED HEALTHCARE [2060]|UHC MEDICA CHOICE [206030]|2192.00||||2192.00|||
100085|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL 0MM OFFSET C TAPER 36MM HIP HIGH PERFORMANCE BIOLOX DELTA|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|2192.00||||2192.00|||
100085|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL 0MM OFFSET C TAPER 36MM HIP HIGH PERFORMANCE BIOLOX DELTA|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|2192.00||||2192.00|||
100085|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL 0MM OFFSET C TAPER 36MM HIP HIGH PERFORMANCE BIOLOX DELTA|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|2192.00||||2192.00|||
100085|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL 0MM OFFSET C TAPER 36MM HIP HIGH PERFORMANCE BIOLOX DELTA|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|2192.00||||2192.00|||
100085|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL 0MM OFFSET C TAPER 36MM HIP HIGH PERFORMANCE BIOLOX DELTA|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|2192.00||||2192.00|||
100085|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL 0MM OFFSET C TAPER 36MM HIP HIGH PERFORMANCE BIOLOX DELTA|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|2192.00||||2192.00|||
100085|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL 0MM OFFSET C TAPER 36MM HIP HIGH PERFORMANCE BIOLOX DELTA|UMR [2035]|UMR OPTIONS [203501]|2192.00||||2192.00|||
100085|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL 0MM OFFSET C TAPER 36MM HIP HIGH PERFORMANCE BIOLOX DELTA|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|2192.00||||2192.00|||
100089|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL -5MM OFFSET C TAPER 36MM HIP HIGH PERFORMANCE BIOLOX DELTA|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|2192.00||||2192.00|1972.8|1972.8|460.32
100089|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL -5MM OFFSET C TAPER 36MM HIP HIGH PERFORMANCE BIOLOX DELTA|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|2192.00||||2192.00|1972.8|1972.8|460.32
100089|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL -5MM OFFSET C TAPER 36MM HIP HIGH PERFORMANCE BIOLOX DELTA|TRUSTMARK [2030]|STARMARK [203000]|2192.00||||2192.00|1972.8|1972.8|460.32
100089|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL -5MM OFFSET C TAPER 36MM HIP HIGH PERFORMANCE BIOLOX DELTA|GROUP PENSION ADMIN [1450]|GPA [145000]|2192.00||||2192.00|1534.4|1972.8|460.32
100089|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL -5MM OFFSET C TAPER 36MM HIP HIGH PERFORMANCE BIOLOX DELTA|<Self-pay>|<Self-pay>|2192.00||||2192.00|657.6|1972.8|460.32
100089|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL -5MM OFFSET C TAPER 36MM HIP HIGH PERFORMANCE BIOLOX DELTA|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|2192.00||||2192.00|1972.8|1972.8|460.32
100089|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL -5MM OFFSET C TAPER 36MM HIP HIGH PERFORMANCE BIOLOX DELTA|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|2192.00||||2192.00|1424.8|1972.8|460.32
100089|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL -5MM OFFSET C TAPER 36MM HIP HIGH PERFORMANCE BIOLOX DELTA|FIRST HEALTH [1375]|BENVEO/UCS [137512]|2192.00||||2192.00|1863.2|1972.8|460.32
100089|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL -5MM OFFSET C TAPER 36MM HIP HIGH PERFORMANCE BIOLOX DELTA|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|2192.00||||2192.00|1972.8|1972.8|460.32
100089|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL -5MM OFFSET C TAPER 36MM HIP HIGH PERFORMANCE BIOLOX DELTA|MULTIPLAN [1680]|IHC HS [168011]|2192.00||||2192.00|1972.8|1972.8|460.32
100089|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL -5MM OFFSET C TAPER 36MM HIP HIGH PERFORMANCE BIOLOX DELTA|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|2192.00||||2192.00|767.2|1972.8|460.32
100089|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL -5MM OFFSET C TAPER 36MM HIP HIGH PERFORMANCE BIOLOX DELTA|MULTIPLAN [1680]|HMA [168003]|2192.00||||2192.00|767.2|1972.8|460.32
100089|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL -5MM OFFSET C TAPER 36MM HIP HIGH PERFORMANCE BIOLOX DELTA|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|2192.00||||2192.00|1972.8|1972.8|460.32
100089|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL -5MM OFFSET C TAPER 36MM HIP HIGH PERFORMANCE BIOLOX DELTA|AETNA [1015]|AMERICAN CONTINENTAL [101507]|2192.00||||2192.00|1534.4|1972.8|460.32
100089|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL -5MM OFFSET C TAPER 36MM HIP HIGH PERFORMANCE BIOLOX DELTA|AETNA [1015]|AETNA ACO WILCO [101532]|2192.00||||2192.00|767.2|1972.8|460.32
100089|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL -5MM OFFSET C TAPER 36MM HIP HIGH PERFORMANCE BIOLOX DELTA|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|2192.00||||2192.00|887.76|1972.8|460.32
100089|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL -5MM OFFSET C TAPER 36MM HIP HIGH PERFORMANCE BIOLOX DELTA|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|2192.00||||2192.00|1269.17|1972.8|460.32
100089|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL -5MM OFFSET C TAPER 36MM HIP HIGH PERFORMANCE BIOLOX DELTA|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|2192.00||||2192.00|1078.46|1972.8|460.32
100089|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL -5MM OFFSET C TAPER 36MM HIP HIGH PERFORMANCE BIOLOX DELTA|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|2192.00||||2192.00|1972.8|1972.8|460.32
100089|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL -5MM OFFSET C TAPER 36MM HIP HIGH PERFORMANCE BIOLOX DELTA|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|2192.00||||2192.00|1424.8|1972.8|460.32
100089|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL -5MM OFFSET C TAPER 36MM HIP HIGH PERFORMANCE BIOLOX DELTA|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|2192.00||||2192.00|942.56|1972.8|460.32
100089|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL -5MM OFFSET C TAPER 36MM HIP HIGH PERFORMANCE BIOLOX DELTA|SAMBA HEALTH [2305]|SAMBA HEALTH [230500]|2192.00||||2192.00|1534.4|1972.8|460.32
100089|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL -5MM OFFSET C TAPER 36MM HIP HIGH PERFORMANCE BIOLOX DELTA|AETNA [1015]|COVENTRY HEALTHCARE [101502]|2192.00||||2192.00|1972.8|1972.8|460.32
100089|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL -5MM OFFSET C TAPER 36MM HIP HIGH PERFORMANCE BIOLOX DELTA|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|2192.00||||2192.00|1972.8|1972.8|460.32
100089|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL -5MM OFFSET C TAPER 36MM HIP HIGH PERFORMANCE BIOLOX DELTA|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|2192.00||||2192.00|699.25|1972.8|460.32
100089|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL -5MM OFFSET C TAPER 36MM HIP HIGH PERFORMANCE BIOLOX DELTA|FIRST HEALTH [1375]|QUALCHOICE [137513]|2192.00||||2192.00|1972.8|1972.8|460.32
100089|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL -5MM OFFSET C TAPER 36MM HIP HIGH PERFORMANCE BIOLOX DELTA|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|2192.00||||2192.00|1424.8|1972.8|460.32
100089|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL -5MM OFFSET C TAPER 36MM HIP HIGH PERFORMANCE BIOLOX DELTA|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|2192.00||||2192.00|1972.8|1972.8|460.32
100089|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL -5MM OFFSET C TAPER 36MM HIP HIGH PERFORMANCE BIOLOX DELTA|HEALTHNET [1495]|HEALTHNET [149500]|2192.00||||2192.00|1972.8|1972.8|460.32
100089|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL -5MM OFFSET C TAPER 36MM HIP HIGH PERFORMANCE BIOLOX DELTA|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|2192.00||||2192.00|1972.8|1972.8|460.32
100089|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL -5MM OFFSET C TAPER 36MM HIP HIGH PERFORMANCE BIOLOX DELTA|CIGNA [1260]|CIGNA - GREAT WEST [126009]|2192.00||||2192.00|1534.4|1972.8|460.32
100089|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL -5MM OFFSET C TAPER 36MM HIP HIGH PERFORMANCE BIOLOX DELTA|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|2192.00||||2192.00|1972.8|1972.8|460.32
100089|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL -5MM OFFSET C TAPER 36MM HIP HIGH PERFORMANCE BIOLOX DELTA|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|2192.00||||2192.00|1972.8|1972.8|460.32
100089|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL -5MM OFFSET C TAPER 36MM HIP HIGH PERFORMANCE BIOLOX DELTA|FMH BENEFIT SERVICES [1390]|FMH [139000]|2192.00||||2192.00|1972.8|1972.8|460.32
100089|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL -5MM OFFSET C TAPER 36MM HIP HIGH PERFORMANCE BIOLOX DELTA|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|2192.00||||2192.00|723.36|1972.8|460.32
100089|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL -5MM OFFSET C TAPER 36MM HIP HIGH PERFORMANCE BIOLOX DELTA|CORESOURCE [1315]|CORESOURCE [131500]|2192.00||||2192.00|1972.8|1972.8|460.32
100089|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL -5MM OFFSET C TAPER 36MM HIP HIGH PERFORMANCE BIOLOX DELTA|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|2192.00||||2192.00|460.32|1972.8|460.32
100089|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL -5MM OFFSET C TAPER 36MM HIP HIGH PERFORMANCE BIOLOX DELTA|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|2192.00||||2192.00|1972.8|1972.8|460.32
100089|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL -5MM OFFSET C TAPER 36MM HIP HIGH PERFORMANCE BIOLOX DELTA|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|2192.00||||2192.00|1096|1972.8|460.32
100089|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL -5MM OFFSET C TAPER 36MM HIP HIGH PERFORMANCE BIOLOX DELTA|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|2192.00||||2192.00|1972.8|1972.8|460.32
100089|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL -5MM OFFSET C TAPER 36MM HIP HIGH PERFORMANCE BIOLOX DELTA|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|2192.00||||2192.00|1972.8|1972.8|460.32
100089|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL -5MM OFFSET C TAPER 36MM HIP HIGH PERFORMANCE BIOLOX DELTA|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|2192.00||||2192.00|767.2|1972.8|460.32
100089|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL -5MM OFFSET C TAPER 36MM HIP HIGH PERFORMANCE BIOLOX DELTA|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|2192.00||||2192.00|1096|1972.8|460.32
100089|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL -5MM OFFSET C TAPER 36MM HIP HIGH PERFORMANCE BIOLOX DELTA|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|2192.00||||2192.00|1972.8|1972.8|460.32
100089|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL -5MM OFFSET C TAPER 36MM HIP HIGH PERFORMANCE BIOLOX DELTA|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|2192.00||||2192.00|1687.84|1972.8|460.32
100089|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL -5MM OFFSET C TAPER 36MM HIP HIGH PERFORMANCE BIOLOX DELTA|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|2192.00||||2192.00|942.56|1972.8|460.32
100089|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL -5MM OFFSET C TAPER 36MM HIP HIGH PERFORMANCE BIOLOX DELTA|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|2192.00||||2192.00|||
100089|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL -5MM OFFSET C TAPER 36MM HIP HIGH PERFORMANCE BIOLOX DELTA|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|2192.00||||2192.00|||
100089|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL -5MM OFFSET C TAPER 36MM HIP HIGH PERFORMANCE BIOLOX DELTA|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|2192.00||||2192.00|||
100089|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL -5MM OFFSET C TAPER 36MM HIP HIGH PERFORMANCE BIOLOX DELTA|UNITED HEALTHCARE [2060]|UHC MEDICA CHOICE [206030]|2192.00||||2192.00|||
100089|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL -5MM OFFSET C TAPER 36MM HIP HIGH PERFORMANCE BIOLOX DELTA|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|2192.00||||2192.00|||
100089|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL -5MM OFFSET C TAPER 36MM HIP HIGH PERFORMANCE BIOLOX DELTA|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|2192.00||||2192.00|||
100089|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL -5MM OFFSET C TAPER 36MM HIP HIGH PERFORMANCE BIOLOX DELTA|GEHA [1415]|GEHA - ASA [141503]|2192.00||||2192.00|||
100089|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL -5MM OFFSET C TAPER 36MM HIP HIGH PERFORMANCE BIOLOX DELTA|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|2192.00||||2192.00|||
100089|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL -5MM OFFSET C TAPER 36MM HIP HIGH PERFORMANCE BIOLOX DELTA|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|2192.00||||2192.00|||
100089|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL -5MM OFFSET C TAPER 36MM HIP HIGH PERFORMANCE BIOLOX DELTA|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|2192.00||||2192.00|||
100089|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL -5MM OFFSET C TAPER 36MM HIP HIGH PERFORMANCE BIOLOX DELTA|CHAMPVA [1240]|CHAMP VA [124000]|2192.00||||2192.00|||
100089|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL -5MM OFFSET C TAPER 36MM HIP HIGH PERFORMANCE BIOLOX DELTA|UMR [2035]|UMR OPTIONS [203501]|2192.00||||2192.00|||
100089|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL -5MM OFFSET C TAPER 36MM HIP HIGH PERFORMANCE BIOLOX DELTA|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|2192.00||||2192.00|||
100089|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL -5MM OFFSET C TAPER 36MM HIP HIGH PERFORMANCE BIOLOX DELTA|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|2192.00||||2192.00|||
100089|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL -5MM OFFSET C TAPER 36MM HIP HIGH PERFORMANCE BIOLOX DELTA|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|2192.00||||2192.00|||
100089|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL -5MM OFFSET C TAPER 36MM HIP HIGH PERFORMANCE BIOLOX DELTA|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|2192.00||||2192.00|||
100089|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL -5MM OFFSET C TAPER 36MM HIP HIGH PERFORMANCE BIOLOX DELTA|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|2192.00||||2192.00|||
100089|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL -5MM OFFSET C TAPER 36MM HIP HIGH PERFORMANCE BIOLOX DELTA|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|2192.00||||2192.00|||
100089|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL -5MM OFFSET C TAPER 36MM HIP HIGH PERFORMANCE BIOLOX DELTA|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|2192.00||||2192.00|||
100089|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL -5MM OFFSET C TAPER 36MM HIP HIGH PERFORMANCE BIOLOX DELTA|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|2192.00||||2192.00|||
100089|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL -5MM OFFSET C TAPER 36MM HIP HIGH PERFORMANCE BIOLOX DELTA|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|2192.00||||2192.00|||
100089|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL -5MM OFFSET C TAPER 36MM HIP HIGH PERFORMANCE BIOLOX DELTA|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|2192.00||||2192.00|||
100089|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL -5MM OFFSET C TAPER 36MM HIP HIGH PERFORMANCE BIOLOX DELTA|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|2192.00||||2192.00|||
100089|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL -5MM OFFSET C TAPER 36MM HIP HIGH PERFORMANCE BIOLOX DELTA|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|2192.00||||2192.00|||
100089|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL -5MM OFFSET C TAPER 36MM HIP HIGH PERFORMANCE BIOLOX DELTA|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|2192.00||||2192.00|||
10009|ERX|0250 - PHARMACY-GENERAL|FAMOTIDINE 10 MG/ML INTRAVENOUS SOLUTION|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|29.00||||29.00|12.47|26.1|6.09
10009|ERX|0250 - PHARMACY-GENERAL|FAMOTIDINE 10 MG/ML INTRAVENOUS SOLUTION|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|29.00||||29.00|12.47|26.1|6.09
10009|ERX|0250 - PHARMACY-GENERAL|FAMOTIDINE 10 MG/ML INTRAVENOUS SOLUTION|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|29.00||||29.00|22.33|26.1|6.09
10009|ERX|0250 - PHARMACY-GENERAL|FAMOTIDINE 10 MG/ML INTRAVENOUS SOLUTION|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|29.00||||29.00|26.1|26.1|6.09
10009|ERX|0250 - PHARMACY-GENERAL|FAMOTIDINE 10 MG/ML INTRAVENOUS SOLUTION|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|29.00||||29.00|26.1|26.1|6.09
10009|ERX|0250 - PHARMACY-GENERAL|FAMOTIDINE 10 MG/ML INTRAVENOUS SOLUTION|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|29.00||||29.00|26.1|26.1|6.09
10009|ERX|0250 - PHARMACY-GENERAL|FAMOTIDINE 10 MG/ML INTRAVENOUS SOLUTION|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|29.00||||29.00|12.47|26.1|6.09
10009|ERX|0250 - PHARMACY-GENERAL|FAMOTIDINE 10 MG/ML INTRAVENOUS SOLUTION|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|29.00||||29.00|14.5|26.1|6.09
10009|ERX|0250 - PHARMACY-GENERAL|FAMOTIDINE 10 MG/ML INTRAVENOUS SOLUTION|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|29.00||||29.00|14.5|26.1|6.09
10009|ERX|0250 - PHARMACY-GENERAL|FAMOTIDINE 10 MG/ML INTRAVENOUS SOLUTION|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|29.00||||29.00|22.33|26.1|6.09
10009|ERX|0250 - PHARMACY-GENERAL|FAMOTIDINE 10 MG/ML INTRAVENOUS SOLUTION|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|29.00||||29.00|6.09|26.1|6.09
10009|ERX|0250 - PHARMACY-GENERAL|FAMOTIDINE 10 MG/ML INTRAVENOUS SOLUTION|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|29.00||||29.00|6.09|26.1|6.09
10009|ERX|0250 - PHARMACY-GENERAL|FAMOTIDINE 10 MG/ML INTRAVENOUS SOLUTION|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|29.00||||29.00|9.57|26.1|6.09
10009|ERX|0250 - PHARMACY-GENERAL|FAMOTIDINE 10 MG/ML INTRAVENOUS SOLUTION|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|29.00||||29.00|26.1|26.1|6.09
10009|ERX|0250 - PHARMACY-GENERAL|FAMOTIDINE 10 MG/ML INTRAVENOUS SOLUTION|FMH BENEFIT SERVICES [1390]|FMH [139000]|29.00||||29.00|26.1|26.1|6.09
10009|ERX|0250 - PHARMACY-GENERAL|FAMOTIDINE 10 MG/ML INTRAVENOUS SOLUTION|FMH BENEFIT SERVICES [1390]|FMH [139000]|29.00||||29.00|26.1|26.1|6.09
10009|ERX|0250 - PHARMACY-GENERAL|FAMOTIDINE 10 MG/ML INTRAVENOUS SOLUTION|CIGNA [1260]|CIGNA - GREAT WEST [126009]|29.00||||29.00|20.3|26.1|6.09
10009|ERX|0250 - PHARMACY-GENERAL|FAMOTIDINE 10 MG/ML INTRAVENOUS SOLUTION|CIGNA [1260]|CIGNA - GREAT WEST [126009]|29.00||||29.00|20.3|26.1|6.09
10009|ERX|0250 - PHARMACY-GENERAL|FAMOTIDINE 10 MG/ML INTRAVENOUS SOLUTION|CIGNA [1260]|CIGNA - GREAT WEST [126009]|29.00||||29.00|20.3|26.1|6.09
10009|ERX|0250 - PHARMACY-GENERAL|FAMOTIDINE 10 MG/ML INTRAVENOUS SOLUTION|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|29.00||||29.00|26.1|26.1|6.09
10009|ERX|0250 - PHARMACY-GENERAL|FAMOTIDINE 10 MG/ML INTRAVENOUS SOLUTION|HEALTHNET [1495]|HEALTHNET [149500]|29.00||||29.00|26.1|26.1|6.09
10009|ERX|0250 - PHARMACY-GENERAL|FAMOTIDINE 10 MG/ML INTRAVENOUS SOLUTION|HEALTHNET [1495]|HEALTHNET [149500]|29.00||||29.00|26.1|26.1|6.09
10009|ERX|0250 - PHARMACY-GENERAL|FAMOTIDINE 10 MG/ML INTRAVENOUS SOLUTION|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|29.00||||29.00|26.1|26.1|6.09
10009|ERX|0250 - PHARMACY-GENERAL|FAMOTIDINE 10 MG/ML INTRAVENOUS SOLUTION|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|29.00||||29.00|26.1|26.1|6.09
10009|ERX|0250 - PHARMACY-GENERAL|FAMOTIDINE 10 MG/ML INTRAVENOUS SOLUTION|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|29.00||||29.00|26.1|26.1|6.09
10009|ERX|0250 - PHARMACY-GENERAL|FAMOTIDINE 10 MG/ML INTRAVENOUS SOLUTION|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|29.00||||29.00|26.1|26.1|6.09
10009|ERX|0250 - PHARMACY-GENERAL|FAMOTIDINE 10 MG/ML INTRAVENOUS SOLUTION|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|29.00||||29.00|9.25|26.1|6.09
10009|ERX|0250 - PHARMACY-GENERAL|FAMOTIDINE 10 MG/ML INTRAVENOUS SOLUTION|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|29.00||||29.00|9.25|26.1|6.09
10009|ERX|0250 - PHARMACY-GENERAL|FAMOTIDINE 10 MG/ML INTRAVENOUS SOLUTION|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|29.00||||29.00|26.1|26.1|6.09
10009|ERX|0250 - PHARMACY-GENERAL|FAMOTIDINE 10 MG/ML INTRAVENOUS SOLUTION|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|29.00||||29.00|26.1|26.1|6.09
10009|ERX|0250 - PHARMACY-GENERAL|FAMOTIDINE 10 MG/ML INTRAVENOUS SOLUTION|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|29.00||||29.00|26.1|26.1|6.09
10009|ERX|0250 - PHARMACY-GENERAL|FAMOTIDINE 10 MG/ML INTRAVENOUS SOLUTION|CORESOURCE [1315]|CORESOURCE [131500]|29.00||||29.00|26.1|26.1|6.09
10009|ERX|0250 - PHARMACY-GENERAL|FAMOTIDINE 10 MG/ML INTRAVENOUS SOLUTION|CORESOURCE [1315]|CORESOURCE [131500]|29.00||||29.00|26.1|26.1|6.09
10009|ERX|0250 - PHARMACY-GENERAL|FAMOTIDINE 10 MG/ML INTRAVENOUS SOLUTION|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|29.00||||29.00|26.1|26.1|6.09
10009|ERX|0250 - PHARMACY-GENERAL|FAMOTIDINE 10 MG/ML INTRAVENOUS SOLUTION|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|29.00||||29.00|18.85|26.1|6.09
10009|ERX|0250 - PHARMACY-GENERAL|FAMOTIDINE 10 MG/ML INTRAVENOUS SOLUTION|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|29.00||||29.00|18.85|26.1|6.09
10009|ERX|0250 - PHARMACY-GENERAL|FAMOTIDINE 10 MG/ML INTRAVENOUS SOLUTION|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|29.00||||29.00|26.1|26.1|6.09
10009|ERX|0250 - PHARMACY-GENERAL|FAMOTIDINE 10 MG/ML INTRAVENOUS SOLUTION|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|29.00||||29.00|18.85|26.1|6.09
10009|ERX|0250 - PHARMACY-GENERAL|FAMOTIDINE 10 MG/ML INTRAVENOUS SOLUTION|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|29.00||||29.00|26.1|26.1|6.09
10009|ERX|0250 - PHARMACY-GENERAL|FAMOTIDINE 10 MG/ML INTRAVENOUS SOLUTION|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|29.00||||29.00|26.1|26.1|6.09
10009|ERX|0250 - PHARMACY-GENERAL|FAMOTIDINE 10 MG/ML INTRAVENOUS SOLUTION|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|29.00||||29.00|26.1|26.1|6.09
10009|ERX|0250 - PHARMACY-GENERAL|FAMOTIDINE 10 MG/ML INTRAVENOUS SOLUTION|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|29.00||||29.00|26.1|26.1|6.09
10009|ERX|0250 - PHARMACY-GENERAL|FAMOTIDINE 10 MG/ML INTRAVENOUS SOLUTION|CORESOURCE [1315]|CORESOURCE [131500]|29.00||||29.00|26.1|26.1|6.09
10009|ERX|0250 - PHARMACY-GENERAL|FAMOTIDINE 10 MG/ML INTRAVENOUS SOLUTION|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|29.00||||29.00|11.75|26.1|6.09
10009|ERX|0250 - PHARMACY-GENERAL|FAMOTIDINE 10 MG/ML INTRAVENOUS SOLUTION|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|29.00||||29.00|11.75|26.1|6.09
10009|ERX|0250 - PHARMACY-GENERAL|FAMOTIDINE 10 MG/ML INTRAVENOUS SOLUTION|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|29.00||||29.00|11.75|26.1|6.09
10009|ERX|0250 - PHARMACY-GENERAL|FAMOTIDINE 10 MG/ML INTRAVENOUS SOLUTION|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|29.00||||29.00|12.47|26.1|6.09
10009|ERX|0250 - PHARMACY-GENERAL|FAMOTIDINE 10 MG/ML INTRAVENOUS SOLUTION|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|29.00||||29.00|16.79|26.1|6.09
10009|ERX|0250 - PHARMACY-GENERAL|FAMOTIDINE 10 MG/ML INTRAVENOUS SOLUTION|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|29.00||||29.00|16.79|26.1|6.09
10009|ERX|0250 - PHARMACY-GENERAL|FAMOTIDINE 10 MG/ML INTRAVENOUS SOLUTION|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|29.00||||29.00|14.27|26.1|6.09
10009|ERX|0250 - PHARMACY-GENERAL|FAMOTIDINE 10 MG/ML INTRAVENOUS SOLUTION|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|29.00||||29.00|14.27|26.1|6.09
10009|ERX|0250 - PHARMACY-GENERAL|FAMOTIDINE 10 MG/ML INTRAVENOUS SOLUTION|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|29.00||||29.00|26.1|26.1|6.09
10009|ERX|0250 - PHARMACY-GENERAL|FAMOTIDINE 10 MG/ML INTRAVENOUS SOLUTION|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|29.00||||29.00|26.1|26.1|6.09
10009|ERX|0250 - PHARMACY-GENERAL|FAMOTIDINE 10 MG/ML INTRAVENOUS SOLUTION|AETNA [1015]|COVENTRY HEALTHCARE [101502]|29.00||||29.00|26.1|26.1|6.09
10009|ERX|0250 - PHARMACY-GENERAL|FAMOTIDINE 10 MG/ML INTRAVENOUS SOLUTION|AETNA [1015]|COVENTRY HEALTHCARE [101502]|29.00||||29.00|26.1|26.1|6.09
10009|ERX|0250 - PHARMACY-GENERAL|FAMOTIDINE 10 MG/ML INTRAVENOUS SOLUTION|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|29.00||||29.00|26.1|26.1|6.09
10009|ERX|0250 - PHARMACY-GENERAL|FAMOTIDINE 10 MG/ML INTRAVENOUS SOLUTION|AETNA [1015]|COVENTRY HEALTHCARE [101502]|29.00||||29.00|26.1|26.1|6.09
10009|ERX|0250 - PHARMACY-GENERAL|FAMOTIDINE 10 MG/ML INTRAVENOUS SOLUTION|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|29.00||||29.00|14.27|26.1|6.09
10009|ERX|0250 - PHARMACY-GENERAL|FAMOTIDINE 10 MG/ML INTRAVENOUS SOLUTION|AETNA [1015]|AMERICAN CONTINENTAL [101507]|29.00||||29.00|20.3|26.1|6.09
10009|ERX|0250 - PHARMACY-GENERAL|FAMOTIDINE 10 MG/ML INTRAVENOUS SOLUTION|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|29.00||||29.00|16.79|26.1|6.09
10009|ERX|0250 - PHARMACY-GENERAL|FAMOTIDINE 10 MG/ML INTRAVENOUS SOLUTION|AETNA [1015]|AMERICAN CONTINENTAL [101507]|29.00||||29.00|20.3|26.1|6.09
10009|ERX|0250 - PHARMACY-GENERAL|FAMOTIDINE 10 MG/ML INTRAVENOUS SOLUTION|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|29.00||||29.00|26.1|26.1|6.09
10009|ERX|0250 - PHARMACY-GENERAL|FAMOTIDINE 10 MG/ML INTRAVENOUS SOLUTION|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|29.00||||29.00|26.1|26.1|6.09
10009|ERX|0250 - PHARMACY-GENERAL|FAMOTIDINE 10 MG/ML INTRAVENOUS SOLUTION|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|29.00||||29.00|26.1|26.1|6.09
10009|ERX|0250 - PHARMACY-GENERAL|FAMOTIDINE 10 MG/ML INTRAVENOUS SOLUTION|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|29.00||||29.00|12.47|26.1|6.09
10009|ERX|0250 - PHARMACY-GENERAL|FAMOTIDINE 10 MG/ML INTRAVENOUS SOLUTION|AETNA [1015]|AMERICAN CONTINENTAL [101507]|29.00||||29.00|20.3|26.1|6.09
10009|ERX|0250 - PHARMACY-GENERAL|FAMOTIDINE 10 MG/ML INTRAVENOUS SOLUTION|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|29.00||||29.00|26.1|26.1|6.09
10009|ERX|0250 - PHARMACY-GENERAL|FAMOTIDINE 10 MG/ML INTRAVENOUS SOLUTION|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|29.00||||29.00|26.1|26.1|6.09
10009|ERX|0250 - PHARMACY-GENERAL|FAMOTIDINE 10 MG/ML INTRAVENOUS SOLUTION|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|29.00||||29.00|12.47|26.1|6.09
10009|ERX|0250 - PHARMACY-GENERAL|FAMOTIDINE 10 MG/ML INTRAVENOUS SOLUTION|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|29.00||||29.00|26.1|26.1|6.09
10009|ERX|0250 - PHARMACY-GENERAL|FAMOTIDINE 10 MG/ML INTRAVENOUS SOLUTION|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|29.00||||29.00|18.85|26.1|6.09
10009|ERX|0250 - PHARMACY-GENERAL|FAMOTIDINE 10 MG/ML INTRAVENOUS SOLUTION|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|29.00||||29.00|18.85|26.1|6.09
10009|ERX|0250 - PHARMACY-GENERAL|FAMOTIDINE 10 MG/ML INTRAVENOUS SOLUTION|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|29.00||||29.00|18.85|26.1|6.09
10009|ERX|0250 - PHARMACY-GENERAL|FAMOTIDINE 10 MG/ML INTRAVENOUS SOLUTION|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|29.00||||29.00|18.85|26.1|6.09
10009|ERX|0250 - PHARMACY-GENERAL|FAMOTIDINE 10 MG/ML INTRAVENOUS SOLUTION|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|29.00||||29.00|||
10009|ERX|0250 - PHARMACY-GENERAL|FAMOTIDINE 10 MG/ML INTRAVENOUS SOLUTION|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|29.00||||29.00|||
10009|ERX|0250 - PHARMACY-GENERAL|FAMOTIDINE 10 MG/ML INTRAVENOUS SOLUTION|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|29.00||||29.00|||
10009|ERX|0250 - PHARMACY-GENERAL|FAMOTIDINE 10 MG/ML INTRAVENOUS SOLUTION|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|29.00||||29.00|||
10009|ERX|0250 - PHARMACY-GENERAL|FAMOTIDINE 10 MG/ML INTRAVENOUS SOLUTION|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|29.00||||29.00|||
10009|ERX|0250 - PHARMACY-GENERAL|FAMOTIDINE 10 MG/ML INTRAVENOUS SOLUTION|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|29.00||||29.00|||
10009|ERX|0250 - PHARMACY-GENERAL|FAMOTIDINE 10 MG/ML INTRAVENOUS SOLUTION|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|29.00||||29.00|||
10009|ERX|0250 - PHARMACY-GENERAL|FAMOTIDINE 10 MG/ML INTRAVENOUS SOLUTION|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|29.00||||29.00|||
10009|ERX|0250 - PHARMACY-GENERAL|FAMOTIDINE 10 MG/ML INTRAVENOUS SOLUTION|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|29.00||||29.00|||
10009|ERX|0250 - PHARMACY-GENERAL|FAMOTIDINE 10 MG/ML INTRAVENOUS SOLUTION|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|29.00||||29.00|||
10009|ERX|0250 - PHARMACY-GENERAL|FAMOTIDINE 10 MG/ML INTRAVENOUS SOLUTION|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|29.00||||29.00|||
10009|ERX|0250 - PHARMACY-GENERAL|FAMOTIDINE 10 MG/ML INTRAVENOUS SOLUTION|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|29.00||||29.00|||
10009|ERX|0250 - PHARMACY-GENERAL|FAMOTIDINE 10 MG/ML INTRAVENOUS SOLUTION|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|29.00||||29.00|||
10009|ERX|0250 - PHARMACY-GENERAL|FAMOTIDINE 10 MG/ML INTRAVENOUS SOLUTION|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|29.00||||29.00|||
10009|ERX|0250 - PHARMACY-GENERAL|FAMOTIDINE 10 MG/ML INTRAVENOUS SOLUTION|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|29.00||||29.00|||
10009|ERX|0250 - PHARMACY-GENERAL|FAMOTIDINE 10 MG/ML INTRAVENOUS SOLUTION|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|29.00||||29.00|||
10009|ERX|0250 - PHARMACY-GENERAL|FAMOTIDINE 10 MG/ML INTRAVENOUS SOLUTION|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|29.00||||29.00|||
10009|ERX|0250 - PHARMACY-GENERAL|FAMOTIDINE 10 MG/ML INTRAVENOUS SOLUTION|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|29.00||||29.00|||
10009|ERX|0250 - PHARMACY-GENERAL|FAMOTIDINE 10 MG/ML INTRAVENOUS SOLUTION|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|29.00||||29.00|||
10009|ERX|0250 - PHARMACY-GENERAL|FAMOTIDINE 10 MG/ML INTRAVENOUS SOLUTION|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|29.00||||29.00|||
10009|ERX|0250 - PHARMACY-GENERAL|FAMOTIDINE 10 MG/ML INTRAVENOUS SOLUTION|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|29.00||||29.00|||
10009|ERX|0250 - PHARMACY-GENERAL|FAMOTIDINE 10 MG/ML INTRAVENOUS SOLUTION|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|29.00||||29.00|||
10009|ERX|0250 - PHARMACY-GENERAL|FAMOTIDINE 10 MG/ML INTRAVENOUS SOLUTION|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|29.00||||29.00|||
10009|ERX|0250 - PHARMACY-GENERAL|FAMOTIDINE 10 MG/ML INTRAVENOUS SOLUTION|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|29.00||||29.00|||
10009|ERX|0250 - PHARMACY-GENERAL|FAMOTIDINE 10 MG/ML INTRAVENOUS SOLUTION|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|29.00||||29.00|||
10009|ERX|0250 - PHARMACY-GENERAL|FAMOTIDINE 10 MG/ML INTRAVENOUS SOLUTION|CHAMPVA [1240]|CHAMP VA [124000]|29.00||||29.00|||
10009|ERX|0250 - PHARMACY-GENERAL|FAMOTIDINE 10 MG/ML INTRAVENOUS SOLUTION|CHAMPVA [1240]|CHAMP VA [124000]|29.00||||29.00|||
10009|ERX|0250 - PHARMACY-GENERAL|FAMOTIDINE 10 MG/ML INTRAVENOUS SOLUTION|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|29.00||||29.00|||
10009|ERX|0250 - PHARMACY-GENERAL|FAMOTIDINE 10 MG/ML INTRAVENOUS SOLUTION|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|29.00||||29.00|||
10009|ERX|0250 - PHARMACY-GENERAL|FAMOTIDINE 10 MG/ML INTRAVENOUS SOLUTION|CHAMPVA [1240]|CHAMP VA [124000]|29.00||||29.00|||
10009|ERX|0250 - PHARMACY-GENERAL|FAMOTIDINE 10 MG/ML INTRAVENOUS SOLUTION|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|29.00||||29.00|||
10009|ERX|0250 - PHARMACY-GENERAL|FAMOTIDINE 10 MG/ML INTRAVENOUS SOLUTION|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|29.00||||29.00|||
10009|ERX|0250 - PHARMACY-GENERAL|FAMOTIDINE 10 MG/ML INTRAVENOUS SOLUTION|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|29.00||||29.00|||
10009|ERX|0250 - PHARMACY-GENERAL|FAMOTIDINE 10 MG/ML INTRAVENOUS SOLUTION|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|29.00||||29.00|||
10009|ERX|0250 - PHARMACY-GENERAL|FAMOTIDINE 10 MG/ML INTRAVENOUS SOLUTION|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|29.00||||29.00|||
10009|ERX|0250 - PHARMACY-GENERAL|FAMOTIDINE 10 MG/ML INTRAVENOUS SOLUTION|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|29.00||||29.00|||
10009|ERX|0250 - PHARMACY-GENERAL|FAMOTIDINE 10 MG/ML INTRAVENOUS SOLUTION|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|29.00||||29.00|||
10009|ERX|0250 - PHARMACY-GENERAL|FAMOTIDINE 10 MG/ML INTRAVENOUS SOLUTION|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|29.00||||29.00|||
10009|ERX|0250 - PHARMACY-GENERAL|FAMOTIDINE 10 MG/ML INTRAVENOUS SOLUTION|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|29.00||||29.00|||
10009|ERX|0250 - PHARMACY-GENERAL|FAMOTIDINE 10 MG/ML INTRAVENOUS SOLUTION|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|29.00||||29.00|||
10009|ERX|0250 - PHARMACY-GENERAL|FAMOTIDINE 10 MG/ML INTRAVENOUS SOLUTION|AETNA [1015]|AETNA ACO WILCO [101532]|29.00||||29.00|||
10009|ERX|0250 - PHARMACY-GENERAL|FAMOTIDINE 10 MG/ML INTRAVENOUS SOLUTION|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|29.00||||29.00|||
10009|ERX|0250 - PHARMACY-GENERAL|FAMOTIDINE 10 MG/ML INTRAVENOUS SOLUTION|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|29.00||||29.00|||
10009|ERX|0250 - PHARMACY-GENERAL|FAMOTIDINE 10 MG/ML INTRAVENOUS SOLUTION|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|29.00||||29.00|||
10009|ERX|0250 - PHARMACY-GENERAL|FAMOTIDINE 10 MG/ML INTRAVENOUS SOLUTION|AETNA [1015]|AETNA ACO WILCO [101532]|29.00||||29.00|||
10009|ERX|0250 - PHARMACY-GENERAL|FAMOTIDINE 10 MG/ML INTRAVENOUS SOLUTION|AETNA [1015]|AETNA ACO WILCO [101532]|29.00||||29.00|||
10009|ERX|0250 - PHARMACY-GENERAL|FAMOTIDINE 10 MG/ML INTRAVENOUS SOLUTION|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|29.00||||29.00|||
10009|ERX|0250 - PHARMACY-GENERAL|FAMOTIDINE 10 MG/ML INTRAVENOUS SOLUTION|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|29.00||||29.00|||
10009|ERX|0250 - PHARMACY-GENERAL|FAMOTIDINE 10 MG/ML INTRAVENOUS SOLUTION|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|29.00||||29.00|||
10009|ERX|0250 - PHARMACY-GENERAL|FAMOTIDINE 10 MG/ML INTRAVENOUS SOLUTION|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|29.00||||29.00|||
10009|ERX|0250 - PHARMACY-GENERAL|FAMOTIDINE 10 MG/ML INTRAVENOUS SOLUTION|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|29.00||||29.00|||
10009|ERX|0250 - PHARMACY-GENERAL|FAMOTIDINE 10 MG/ML INTRAVENOUS SOLUTION|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|29.00||||29.00|||
10009|ERX|0250 - PHARMACY-GENERAL|FAMOTIDINE 10 MG/ML INTRAVENOUS SOLUTION|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|29.00||||29.00|26.1|26.1|6.09
10009|ERX|0250 - PHARMACY-GENERAL|FAMOTIDINE 10 MG/ML INTRAVENOUS SOLUTION|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|29.00||||29.00|26.1|26.1|6.09
10009|ERX|0250 - PHARMACY-GENERAL|FAMOTIDINE 10 MG/ML INTRAVENOUS SOLUTION|<Self-pay>|<Self-pay>|29.00||||29.00|8.7|26.1|6.09
10009|ERX|0250 - PHARMACY-GENERAL|FAMOTIDINE 10 MG/ML INTRAVENOUS SOLUTION|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|29.00||||29.00|26.1|26.1|6.09
10009|ERX|0250 - PHARMACY-GENERAL|FAMOTIDINE 10 MG/ML INTRAVENOUS SOLUTION|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|29.00||||29.00|9.57|26.1|6.09
10009|ERX|0250 - PHARMACY-GENERAL|FAMOTIDINE 10 MG/ML INTRAVENOUS SOLUTION|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|29.00||||29.00|9.57|26.1|6.09
10009|ERX|0250 - PHARMACY-GENERAL|FAMOTIDINE 10 MG/ML INTRAVENOUS SOLUTION|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|29.00||||29.00|9.25|26.1|6.09
10009|ERX|0250 - PHARMACY-GENERAL|FAMOTIDINE 10 MG/ML INTRAVENOUS SOLUTION|FIRST HEALTH [1375]|BENVEO/UCS [137512]|29.00||||29.00|24.65|26.1|6.09
10009|ERX|0250 - PHARMACY-GENERAL|FAMOTIDINE 10 MG/ML INTRAVENOUS SOLUTION|<Self-pay>|<Self-pay>|29.00||||29.00|8.7|26.1|6.09
10009|ERX|0250 - PHARMACY-GENERAL|FAMOTIDINE 10 MG/ML INTRAVENOUS SOLUTION|FIRST HEALTH [1375]|BENVEO/UCS [137512]|29.00||||29.00|24.65|26.1|6.09
10009|ERX|0250 - PHARMACY-GENERAL|FAMOTIDINE 10 MG/ML INTRAVENOUS SOLUTION|FMH BENEFIT SERVICES [1390]|FMH [139000]|29.00||||29.00|26.1|26.1|6.09
10009|ERX|0250 - PHARMACY-GENERAL|FAMOTIDINE 10 MG/ML INTRAVENOUS SOLUTION|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|29.00||||29.00|26.1|26.1|6.09
10009|ERX|0250 - PHARMACY-GENERAL|FAMOTIDINE 10 MG/ML INTRAVENOUS SOLUTION|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|29.00||||29.00|26.1|26.1|6.09
10009|ERX|0250 - PHARMACY-GENERAL|FAMOTIDINE 10 MG/ML INTRAVENOUS SOLUTION|FIRST HEALTH [1375]|BENVEO/UCS [137512]|29.00||||29.00|24.65|26.1|6.09
10009|ERX|0250 - PHARMACY-GENERAL|FAMOTIDINE 10 MG/ML INTRAVENOUS SOLUTION|FIRST HEALTH [1375]|QUALCHOICE [137513]|29.00||||29.00|26.1|26.1|6.09
10009|ERX|0250 - PHARMACY-GENERAL|FAMOTIDINE 10 MG/ML INTRAVENOUS SOLUTION|HEALTHNET [1495]|HEALTHNET [149500]|29.00||||29.00|26.1|26.1|6.09
10009|ERX|0250 - PHARMACY-GENERAL|FAMOTIDINE 10 MG/ML INTRAVENOUS SOLUTION|FIRST HEALTH [1375]|QUALCHOICE [137513]|29.00||||29.00|26.1|26.1|6.09
10009|ERX|0250 - PHARMACY-GENERAL|FAMOTIDINE 10 MG/ML INTRAVENOUS SOLUTION|FIRST HEALTH [1375]|QUALCHOICE [137513]|29.00||||29.00|26.1|26.1|6.09
10009|ERX|0250 - PHARMACY-GENERAL|FAMOTIDINE 10 MG/ML INTRAVENOUS SOLUTION|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|29.00||||29.00|26.1|26.1|6.09
10009|ERX|0250 - PHARMACY-GENERAL|FAMOTIDINE 10 MG/ML INTRAVENOUS SOLUTION|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|29.00||||29.00|18.85|26.1|6.09
10009|ERX|0250 - PHARMACY-GENERAL|FAMOTIDINE 10 MG/ML INTRAVENOUS SOLUTION|GROUP PENSION ADMIN [1450]|GPA [145000]|29.00||||29.00|20.3|26.1|6.09
10009|ERX|0250 - PHARMACY-GENERAL|FAMOTIDINE 10 MG/ML INTRAVENOUS SOLUTION|GROUP PENSION ADMIN [1450]|GPA [145000]|29.00||||29.00|20.3|26.1|6.09
10009|ERX|0250 - PHARMACY-GENERAL|FAMOTIDINE 10 MG/ML INTRAVENOUS SOLUTION|GROUP PENSION ADMIN [1450]|GPA [145000]|29.00||||29.00|20.3|26.1|6.09
10009|ERX|0250 - PHARMACY-GENERAL|FAMOTIDINE 10 MG/ML INTRAVENOUS SOLUTION|<Self-pay>|<Self-pay>|29.00||||29.00|8.7|26.1|6.09
10009|ERX|0250 - PHARMACY-GENERAL|FAMOTIDINE 10 MG/ML INTRAVENOUS SOLUTION|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|29.00||||29.00|18.85|26.1|6.09
10009|ERX|0250 - PHARMACY-GENERAL|FAMOTIDINE 10 MG/ML INTRAVENOUS SOLUTION|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|29.00||||29.00|26.1|26.1|6.09
10009|ERX|0250 - PHARMACY-GENERAL|FAMOTIDINE 10 MG/ML INTRAVENOUS SOLUTION|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|29.00||||29.00|26.1|26.1|6.09
10009|ERX|0250 - PHARMACY-GENERAL|FAMOTIDINE 10 MG/ML INTRAVENOUS SOLUTION|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|29.00||||29.00|26.1|26.1|6.09
10009|ERX|0250 - PHARMACY-GENERAL|FAMOTIDINE 10 MG/ML INTRAVENOUS SOLUTION|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|29.00||||29.00|6.09|26.1|6.09
10009|ERX|0250 - PHARMACY-GENERAL|FAMOTIDINE 10 MG/ML INTRAVENOUS SOLUTION|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|29.00||||29.00|14.5|26.1|6.09
10009|ERX|0250 - PHARMACY-GENERAL|FAMOTIDINE 10 MG/ML INTRAVENOUS SOLUTION|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|29.00||||29.00|22.33|26.1|6.09
10009|ERX|0250 - PHARMACY-GENERAL|FAMOTIDINE 10 MG/ML INTRAVENOUS SOLUTION|TRUSTMARK [2030]|STARMARK [203000]|29.00||||29.00|26.1|26.1|6.09
10009|ERX|0250 - PHARMACY-GENERAL|FAMOTIDINE 10 MG/ML INTRAVENOUS SOLUTION|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|29.00||||29.00|26.1|26.1|6.09
10009|ERX|0250 - PHARMACY-GENERAL|FAMOTIDINE 10 MG/ML INTRAVENOUS SOLUTION|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|29.00||||29.00|26.1|26.1|6.09
10009|ERX|0250 - PHARMACY-GENERAL|FAMOTIDINE 10 MG/ML INTRAVENOUS SOLUTION|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|29.00||||29.00|26.1|26.1|6.09
10009|ERX|0250 - PHARMACY-GENERAL|FAMOTIDINE 10 MG/ML INTRAVENOUS SOLUTION|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|29.00||||29.00|26.1|26.1|6.09
10009|ERX|0250 - PHARMACY-GENERAL|FAMOTIDINE 10 MG/ML INTRAVENOUS SOLUTION|MULTIPLAN [1680]|IHC HS [168011]|29.00||||29.00|26.1|26.1|6.09
10009|ERX|0250 - PHARMACY-GENERAL|FAMOTIDINE 10 MG/ML INTRAVENOUS SOLUTION|MULTIPLAN [1680]|IHC HS [168011]|29.00||||29.00|26.1|26.1|6.09
10009|ERX|0250 - PHARMACY-GENERAL|FAMOTIDINE 10 MG/ML INTRAVENOUS SOLUTION|MULTIPLAN [1680]|IHC HS [168011]|29.00||||29.00|26.1|26.1|6.09
10009|ERX|0250 - PHARMACY-GENERAL|FAMOTIDINE 10 MG/ML INTRAVENOUS SOLUTION|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|29.00||||29.00|26.1|26.1|6.09
10009|ERX|0250 - PHARMACY-GENERAL|FAMOTIDINE 10 MG/ML INTRAVENOUS SOLUTION|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|29.00||||29.00|26.1|26.1|6.09
10009|ERX|0250 - PHARMACY-GENERAL|FAMOTIDINE 10 MG/ML INTRAVENOUS SOLUTION|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|29.00||||29.00|26.1|26.1|6.09
10009|ERX|0250 - PHARMACY-GENERAL|FAMOTIDINE 10 MG/ML INTRAVENOUS SOLUTION|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|29.00||||29.00|26.1|26.1|6.09
10009|ERX|0250 - PHARMACY-GENERAL|FAMOTIDINE 10 MG/ML INTRAVENOUS SOLUTION|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|29.00||||29.00|26.1|26.1|6.09
10009|ERX|0250 - PHARMACY-GENERAL|FAMOTIDINE 10 MG/ML INTRAVENOUS SOLUTION|SAMBA HEALTH [2305]|SAMBA HEALTH [230500]|29.00||||29.00|20.3|26.1|6.09
10009|ERX|0250 - PHARMACY-GENERAL|FAMOTIDINE 10 MG/ML INTRAVENOUS SOLUTION|SAMBA HEALTH [2305]|SAMBA HEALTH [230500]|29.00||||29.00|20.3|26.1|6.09
10009|ERX|0250 - PHARMACY-GENERAL|FAMOTIDINE 10 MG/ML INTRAVENOUS SOLUTION|SAMBA HEALTH [2305]|SAMBA HEALTH [230500]|29.00||||29.00|20.3|26.1|6.09
10009|ERX|0250 - PHARMACY-GENERAL|FAMOTIDINE 10 MG/ML INTRAVENOUS SOLUTION|TRUSTMARK [2030]|STARMARK [203000]|29.00||||29.00|26.1|26.1|6.09
10009|ERX|0250 - PHARMACY-GENERAL|FAMOTIDINE 10 MG/ML INTRAVENOUS SOLUTION|TRUSTMARK [2030]|STARMARK [203000]|29.00||||29.00|26.1|26.1|6.09
10009|ERX|0250 - PHARMACY-GENERAL|FAMOTIDINE 10 MG/ML INTRAVENOUS SOLUTION|GEHA [1415]|GEHA - ASA [141503]|29.00||||29.00|||
10009|ERX|0250 - PHARMACY-GENERAL|FAMOTIDINE 10 MG/ML INTRAVENOUS SOLUTION|GEHA [1415]|GEHA - ASA [141503]|29.00||||29.00|||
10009|ERX|0250 - PHARMACY-GENERAL|FAMOTIDINE 10 MG/ML INTRAVENOUS SOLUTION|UNITED HEALTHCARE [2060]|UHC MEDICA CHOICE [206030]|29.00||||29.00|||
10009|ERX|0250 - PHARMACY-GENERAL|FAMOTIDINE 10 MG/ML INTRAVENOUS SOLUTION|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|29.00||||29.00|||
10009|ERX|0250 - PHARMACY-GENERAL|FAMOTIDINE 10 MG/ML INTRAVENOUS SOLUTION|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|29.00||||29.00|||
10009|ERX|0250 - PHARMACY-GENERAL|FAMOTIDINE 10 MG/ML INTRAVENOUS SOLUTION|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|29.00||||29.00|||
10009|ERX|0250 - PHARMACY-GENERAL|FAMOTIDINE 10 MG/ML INTRAVENOUS SOLUTION|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|29.00||||29.00|||
10009|ERX|0250 - PHARMACY-GENERAL|FAMOTIDINE 10 MG/ML INTRAVENOUS SOLUTION|UNITED HEALTHCARE [2060]|UHC MEDICA CHOICE [206030]|29.00||||29.00|||
10009|ERX|0250 - PHARMACY-GENERAL|FAMOTIDINE 10 MG/ML INTRAVENOUS SOLUTION|UNITED HEALTHCARE [2060]|UHC MEDICA CHOICE [206030]|29.00||||29.00|||
10009|ERX|0250 - PHARMACY-GENERAL|FAMOTIDINE 10 MG/ML INTRAVENOUS SOLUTION|GEHA [1415]|GEHA - ASA [141503]|29.00||||29.00|||
10009|ERX|0250 - PHARMACY-GENERAL|FAMOTIDINE 10 MG/ML INTRAVENOUS SOLUTION|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|29.00||||29.00|||
10009|ERX|0250 - PHARMACY-GENERAL|FAMOTIDINE 10 MG/ML INTRAVENOUS SOLUTION|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|29.00||||29.00|||
10009|ERX|0250 - PHARMACY-GENERAL|FAMOTIDINE 10 MG/ML INTRAVENOUS SOLUTION|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|29.00||||29.00|||
10009|ERX|0250 - PHARMACY-GENERAL|FAMOTIDINE 10 MG/ML INTRAVENOUS SOLUTION|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|29.00||||29.00|||
10009|ERX|0250 - PHARMACY-GENERAL|FAMOTIDINE 10 MG/ML INTRAVENOUS SOLUTION|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|29.00||||29.00|||
10009|ERX|0250 - PHARMACY-GENERAL|FAMOTIDINE 10 MG/ML INTRAVENOUS SOLUTION|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|29.00||||29.00|||
10009|ERX|0250 - PHARMACY-GENERAL|FAMOTIDINE 10 MG/ML INTRAVENOUS SOLUTION|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|29.00||||29.00|||
10009|ERX|0250 - PHARMACY-GENERAL|FAMOTIDINE 10 MG/ML INTRAVENOUS SOLUTION|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|29.00||||29.00|||
10009|ERX|0250 - PHARMACY-GENERAL|FAMOTIDINE 10 MG/ML INTRAVENOUS SOLUTION|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|29.00||||29.00|||
10009|ERX|0250 - PHARMACY-GENERAL|FAMOTIDINE 10 MG/ML INTRAVENOUS SOLUTION|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|29.00||||29.00|||
10009|ERX|0250 - PHARMACY-GENERAL|FAMOTIDINE 10 MG/ML INTRAVENOUS SOLUTION|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|29.00||||29.00|||
10009|ERX|0250 - PHARMACY-GENERAL|FAMOTIDINE 10 MG/ML INTRAVENOUS SOLUTION|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|29.00||||29.00|||
10009|ERX|0250 - PHARMACY-GENERAL|FAMOTIDINE 10 MG/ML INTRAVENOUS SOLUTION|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|29.00||||29.00|||
10009|ERX|0250 - PHARMACY-GENERAL|FAMOTIDINE 10 MG/ML INTRAVENOUS SOLUTION|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|29.00||||29.00|||
10009|ERX|0250 - PHARMACY-GENERAL|FAMOTIDINE 10 MG/ML INTRAVENOUS SOLUTION|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|29.00||||29.00|||
10009|ERX|0250 - PHARMACY-GENERAL|FAMOTIDINE 10 MG/ML INTRAVENOUS SOLUTION|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|29.00||||29.00|||
10009|ERX|0250 - PHARMACY-GENERAL|FAMOTIDINE 10 MG/ML INTRAVENOUS SOLUTION|MULTIPLAN [1680]|HMA [168003]|29.00||||29.00|||
10009|ERX|0250 - PHARMACY-GENERAL|FAMOTIDINE 10 MG/ML INTRAVENOUS SOLUTION|MULTIPLAN [1680]|HMA [168003]|29.00||||29.00|||
10009|ERX|0250 - PHARMACY-GENERAL|FAMOTIDINE 10 MG/ML INTRAVENOUS SOLUTION|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|29.00||||29.00|||
10009|ERX|0250 - PHARMACY-GENERAL|FAMOTIDINE 10 MG/ML INTRAVENOUS SOLUTION|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|29.00||||29.00|||
10009|ERX|0250 - PHARMACY-GENERAL|FAMOTIDINE 10 MG/ML INTRAVENOUS SOLUTION|MULTIPLAN [1680]|HMA [168003]|29.00||||29.00|||
10009|ERX|0250 - PHARMACY-GENERAL|FAMOTIDINE 10 MG/ML INTRAVENOUS SOLUTION|UMR [2035]|UMR OPTIONS [203501]|29.00||||29.00|||
10009|ERX|0250 - PHARMACY-GENERAL|FAMOTIDINE 10 MG/ML INTRAVENOUS SOLUTION|UMR [2035]|UMR OPTIONS [203501]|29.00||||29.00|||
10009|ERX|0250 - PHARMACY-GENERAL|FAMOTIDINE 10 MG/ML INTRAVENOUS SOLUTION|UMR [2035]|UMR OPTIONS [203501]|29.00||||29.00|||
10009|ERX|0250 - PHARMACY-GENERAL|FAMOTIDINE 10 MG/ML INTRAVENOUS SOLUTION|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|29.00||||29.00|||
10009|ERX|0250 - PHARMACY-GENERAL|FAMOTIDINE 10 MG/ML INTRAVENOUS SOLUTION|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|29.00||||29.00|||
10009|ERX|0250 - PHARMACY-GENERAL|FAMOTIDINE 10 MG/ML INTRAVENOUS SOLUTION|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|29.00||||29.00|||
10009|ERX|0250 - PHARMACY-GENERAL|FAMOTIDINE 10 MG/ML INTRAVENOUS SOLUTION|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|29.00||||29.00|||
100098|SUP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|PASTE OSTOMY EAKIN COHESIVE 2.1 OZ TUBE|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|10.00||||10.00|9|9|2.1
100098|SUP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|PASTE OSTOMY EAKIN COHESIVE 2.1 OZ TUBE|AETNA [1015]|AMERICAN CONTINENTAL [101507]|10.00||||10.00|7|9|2.1
100098|SUP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|PASTE OSTOMY EAKIN COHESIVE 2.1 OZ TUBE|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|10.00||||10.00|9|9|2.1
100098|SUP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|PASTE OSTOMY EAKIN COHESIVE 2.1 OZ TUBE|TRUSTMARK [2030]|STARMARK [203000]|10.00||||10.00|9|9|2.1
100098|SUP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|PASTE OSTOMY EAKIN COHESIVE 2.1 OZ TUBE|GROUP PENSION ADMIN [1450]|GPA [145000]|10.00||||10.00|7|9|2.1
100098|SUP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|PASTE OSTOMY EAKIN COHESIVE 2.1 OZ TUBE|FIRST HEALTH [1375]|QUALCHOICE [137513]|10.00||||10.00|9|9|2.1
100098|SUP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|PASTE OSTOMY EAKIN COHESIVE 2.1 OZ TUBE|AETNA [1015]|COVENTRY HEALTHCARE [101502]|10.00||||10.00|9|9|2.1
100098|SUP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|PASTE OSTOMY EAKIN COHESIVE 2.1 OZ TUBE|SAMBA HEALTH [2305]|SAMBA HEALTH [230500]|10.00||||10.00|7|9|2.1
100098|SUP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|PASTE OSTOMY EAKIN COHESIVE 2.1 OZ TUBE|<Self-pay>|<Self-pay>|10.00||||10.00|3|9|2.1
100098|SUP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|PASTE OSTOMY EAKIN COHESIVE 2.1 OZ TUBE|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|10.00||||10.00|9|9|2.1
100098|SUP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|PASTE OSTOMY EAKIN COHESIVE 2.1 OZ TUBE|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|10.00||||10.00|6.5|9|2.1
100098|SUP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|PASTE OSTOMY EAKIN COHESIVE 2.1 OZ TUBE|MULTIPLAN [1680]|IHC HS [168011]|10.00||||10.00|9|9|2.1
100098|SUP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|PASTE OSTOMY EAKIN COHESIVE 2.1 OZ TUBE|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|10.00||||10.00|9|9|2.1
100098|SUP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|PASTE OSTOMY EAKIN COHESIVE 2.1 OZ TUBE|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|10.00||||10.00|9|9|2.1
100098|SUP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|PASTE OSTOMY EAKIN COHESIVE 2.1 OZ TUBE|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|10.00||||10.00|4.92|9|2.1
100098|SUP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|PASTE OSTOMY EAKIN COHESIVE 2.1 OZ TUBE|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|10.00||||10.00|4.3|9|2.1
100098|SUP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|PASTE OSTOMY EAKIN COHESIVE 2.1 OZ TUBE|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|10.00||||10.00|9|9|2.1
100098|SUP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|PASTE OSTOMY EAKIN COHESIVE 2.1 OZ TUBE|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|10.00||||10.00|9|9|2.1
100098|SUP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|PASTE OSTOMY EAKIN COHESIVE 2.1 OZ TUBE|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|10.00||||10.00|5.79|9|2.1
100098|SUP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|PASTE OSTOMY EAKIN COHESIVE 2.1 OZ TUBE|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|10.00||||10.00|4.05|9|2.1
100098|SUP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|PASTE OSTOMY EAKIN COHESIVE 2.1 OZ TUBE|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|10.00||||10.00|6.5|9|2.1
100098|SUP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|PASTE OSTOMY EAKIN COHESIVE 2.1 OZ TUBE|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|10.00||||10.00|9|9|2.1
100098|SUP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|PASTE OSTOMY EAKIN COHESIVE 2.1 OZ TUBE|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|10.00||||10.00|9|9|2.1
100098|SUP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|PASTE OSTOMY EAKIN COHESIVE 2.1 OZ TUBE|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|10.00||||10.00|9|9|2.1
100098|SUP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|PASTE OSTOMY EAKIN COHESIVE 2.1 OZ TUBE|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|10.00||||10.00|6.5|9|2.1
100098|SUP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|PASTE OSTOMY EAKIN COHESIVE 2.1 OZ TUBE|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|10.00||||10.00|9|9|2.1
100098|SUP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|PASTE OSTOMY EAKIN COHESIVE 2.1 OZ TUBE|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|10.00||||10.00|3.19|9|2.1
100098|SUP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|PASTE OSTOMY EAKIN COHESIVE 2.1 OZ TUBE|HEALTHNET [1495]|HEALTHNET [149500]|10.00||||10.00|9|9|2.1
100098|SUP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|PASTE OSTOMY EAKIN COHESIVE 2.1 OZ TUBE|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|10.00||||10.00|9|9|2.1
100098|SUP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|PASTE OSTOMY EAKIN COHESIVE 2.1 OZ TUBE|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|10.00||||10.00|9|9|2.1
100098|SUP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|PASTE OSTOMY EAKIN COHESIVE 2.1 OZ TUBE|FIRST HEALTH [1375]|BENVEO/UCS [137512]|10.00||||10.00|8.5|9|2.1
100098|SUP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|PASTE OSTOMY EAKIN COHESIVE 2.1 OZ TUBE|CIGNA [1260]|CIGNA - GREAT WEST [126009]|10.00||||10.00|7|9|2.1
100098|SUP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|PASTE OSTOMY EAKIN COHESIVE 2.1 OZ TUBE|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|10.00||||10.00|9|9|2.1
100098|SUP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|PASTE OSTOMY EAKIN COHESIVE 2.1 OZ TUBE|FMH BENEFIT SERVICES [1390]|FMH [139000]|10.00||||10.00|9|9|2.1
100098|SUP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|PASTE OSTOMY EAKIN COHESIVE 2.1 OZ TUBE|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|10.00||||10.00|3.3|9|2.1
100098|SUP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|PASTE OSTOMY EAKIN COHESIVE 2.1 OZ TUBE|CORESOURCE [1315]|CORESOURCE [131500]|10.00||||10.00|9|9|2.1
100098|SUP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|PASTE OSTOMY EAKIN COHESIVE 2.1 OZ TUBE|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|10.00||||10.00|2.1|9|2.1
100098|SUP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|PASTE OSTOMY EAKIN COHESIVE 2.1 OZ TUBE|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|10.00||||10.00|5|9|2.1
100098|SUP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|PASTE OSTOMY EAKIN COHESIVE 2.1 OZ TUBE|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|10.00||||10.00|9|9|2.1
100098|SUP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|PASTE OSTOMY EAKIN COHESIVE 2.1 OZ TUBE|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|10.00||||10.00|7.7|9|2.1
100098|SUP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|PASTE OSTOMY EAKIN COHESIVE 2.1 OZ TUBE|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|10.00||||10.00|4.3|9|2.1
100098|SUP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|PASTE OSTOMY EAKIN COHESIVE 2.1 OZ TUBE|UMR [2035]|UMR OPTIONS [203501]|10.00||||10.00|||
100098|SUP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|PASTE OSTOMY EAKIN COHESIVE 2.1 OZ TUBE|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|10.00||||10.00|||
100098|SUP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|PASTE OSTOMY EAKIN COHESIVE 2.1 OZ TUBE|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|10.00||||10.00|||
100098|SUP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|PASTE OSTOMY EAKIN COHESIVE 2.1 OZ TUBE|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|10.00||||10.00|||
100098|SUP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|PASTE OSTOMY EAKIN COHESIVE 2.1 OZ TUBE|GEHA [1415]|GEHA - ASA [141503]|10.00||||10.00|||
100098|SUP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|PASTE OSTOMY EAKIN COHESIVE 2.1 OZ TUBE|MULTIPLAN [1680]|HMA [168003]|10.00||||10.00|||
100098|SUP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|PASTE OSTOMY EAKIN COHESIVE 2.1 OZ TUBE|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|10.00||||10.00|||
100098|SUP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|PASTE OSTOMY EAKIN COHESIVE 2.1 OZ TUBE|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|10.00||||10.00|||
100098|SUP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|PASTE OSTOMY EAKIN COHESIVE 2.1 OZ TUBE|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|10.00||||10.00|||
100098|SUP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|PASTE OSTOMY EAKIN COHESIVE 2.1 OZ TUBE|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|10.00||||10.00|||
100098|SUP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|PASTE OSTOMY EAKIN COHESIVE 2.1 OZ TUBE|CHAMPVA [1240]|CHAMP VA [124000]|10.00||||10.00|||
100098|SUP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|PASTE OSTOMY EAKIN COHESIVE 2.1 OZ TUBE|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|10.00||||10.00|||
100098|SUP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|PASTE OSTOMY EAKIN COHESIVE 2.1 OZ TUBE|AETNA [1015]|AETNA ACO WILCO [101532]|10.00||||10.00|||
100098|SUP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|PASTE OSTOMY EAKIN COHESIVE 2.1 OZ TUBE|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|10.00||||10.00|||
100098|SUP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|PASTE OSTOMY EAKIN COHESIVE 2.1 OZ TUBE|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|10.00||||10.00|||
100098|SUP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|PASTE OSTOMY EAKIN COHESIVE 2.1 OZ TUBE|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|10.00||||10.00|||
100098|SUP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|PASTE OSTOMY EAKIN COHESIVE 2.1 OZ TUBE|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|10.00||||10.00|||
100098|SUP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|PASTE OSTOMY EAKIN COHESIVE 2.1 OZ TUBE|UNITED HEALTHCARE [2060]|UHC MEDICA CHOICE [206030]|10.00||||10.00|||
100098|SUP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|PASTE OSTOMY EAKIN COHESIVE 2.1 OZ TUBE|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|10.00||||10.00|||
100098|SUP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|PASTE OSTOMY EAKIN COHESIVE 2.1 OZ TUBE|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|10.00||||10.00|||
100098|SUP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|PASTE OSTOMY EAKIN COHESIVE 2.1 OZ TUBE|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|10.00||||10.00|||
100098|SUP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|PASTE OSTOMY EAKIN COHESIVE 2.1 OZ TUBE|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|10.00||||10.00|||
100098|SUP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|PASTE OSTOMY EAKIN COHESIVE 2.1 OZ TUBE|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|10.00||||10.00|||
100098|SUP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|PASTE OSTOMY EAKIN COHESIVE 2.1 OZ TUBE|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|10.00||||10.00|||
100098|SUP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|PASTE OSTOMY EAKIN COHESIVE 2.1 OZ TUBE|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|10.00||||10.00|||
100098|SUP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|PASTE OSTOMY EAKIN COHESIVE 2.1 OZ TUBE|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|10.00||||10.00|||
100098|SUP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|PASTE OSTOMY EAKIN COHESIVE 2.1 OZ TUBE|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|10.00||||10.00|||
100098|SUP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|PASTE OSTOMY EAKIN COHESIVE 2.1 OZ TUBE|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|10.00||||10.00|||
100098|SUP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|PASTE OSTOMY EAKIN COHESIVE 2.1 OZ TUBE|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|10.00||||10.00|||
100098|SUP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|PASTE OSTOMY EAKIN COHESIVE 2.1 OZ TUBE|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|10.00||||10.00|||
100100|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SUBSTITUTE BONE GRAFT XEMPLIFI DEMINERALIZED BONE MATRIX 10 ML PLUS STERILE LATEX FREE|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|4200.00||||4200.00|3780|3780|882
100100|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SUBSTITUTE BONE GRAFT XEMPLIFI DEMINERALIZED BONE MATRIX 10 ML PLUS STERILE LATEX FREE|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|4200.00||||4200.00|2100|3780|882
100100|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SUBSTITUTE BONE GRAFT XEMPLIFI DEMINERALIZED BONE MATRIX 10 ML PLUS STERILE LATEX FREE|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|4200.00||||4200.00|882|3780|882
100100|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SUBSTITUTE BONE GRAFT XEMPLIFI DEMINERALIZED BONE MATRIX 10 ML PLUS STERILE LATEX FREE|FMH BENEFIT SERVICES [1390]|FMH [139000]|4200.00||||4200.00|3780|3780|882
100100|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SUBSTITUTE BONE GRAFT XEMPLIFI DEMINERALIZED BONE MATRIX 10 ML PLUS STERILE LATEX FREE|CIGNA [1260]|CIGNA - GREAT WEST [126009]|4200.00||||4200.00|2940|3780|882
100100|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SUBSTITUTE BONE GRAFT XEMPLIFI DEMINERALIZED BONE MATRIX 10 ML PLUS STERILE LATEX FREE|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|4200.00||||4200.00|3780|3780|882
100100|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SUBSTITUTE BONE GRAFT XEMPLIFI DEMINERALIZED BONE MATRIX 10 ML PLUS STERILE LATEX FREE|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|4200.00||||4200.00|1339.8|3780|882
100100|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SUBSTITUTE BONE GRAFT XEMPLIFI DEMINERALIZED BONE MATRIX 10 ML PLUS STERILE LATEX FREE|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|4200.00||||4200.00|2100|3780|882
100100|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SUBSTITUTE BONE GRAFT XEMPLIFI DEMINERALIZED BONE MATRIX 10 ML PLUS STERILE LATEX FREE|CORESOURCE [1315]|CORESOURCE [131500]|4200.00||||4200.00|3780|3780|882
100100|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SUBSTITUTE BONE GRAFT XEMPLIFI DEMINERALIZED BONE MATRIX 10 ML PLUS STERILE LATEX FREE|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|4200.00||||4200.00|2730|3780|882
100100|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SUBSTITUTE BONE GRAFT XEMPLIFI DEMINERALIZED BONE MATRIX 10 ML PLUS STERILE LATEX FREE|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|4200.00||||4200.00|3780|3780|882
100100|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SUBSTITUTE BONE GRAFT XEMPLIFI DEMINERALIZED BONE MATRIX 10 ML PLUS STERILE LATEX FREE|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|4200.00||||4200.00|3780|3780|882
100100|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SUBSTITUTE BONE GRAFT XEMPLIFI DEMINERALIZED BONE MATRIX 10 ML PLUS STERILE LATEX FREE|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|4200.00||||4200.00|1806|3780|882
100100|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SUBSTITUTE BONE GRAFT XEMPLIFI DEMINERALIZED BONE MATRIX 10 ML PLUS STERILE LATEX FREE|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|4200.00||||4200.00|3780|3780|882
100100|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SUBSTITUTE BONE GRAFT XEMPLIFI DEMINERALIZED BONE MATRIX 10 ML PLUS STERILE LATEX FREE|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|4200.00||||4200.00|3780|3780|882
100100|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SUBSTITUTE BONE GRAFT XEMPLIFI DEMINERALIZED BONE MATRIX 10 ML PLUS STERILE LATEX FREE|MULTIPLAN [1680]|HMA [168003]|4200.00||||4200.00|1470|3780|882
100100|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SUBSTITUTE BONE GRAFT XEMPLIFI DEMINERALIZED BONE MATRIX 10 ML PLUS STERILE LATEX FREE|MULTIPLAN [1680]|IHC HS [168011]|4200.00||||4200.00|3780|3780|882
100100|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SUBSTITUTE BONE GRAFT XEMPLIFI DEMINERALIZED BONE MATRIX 10 ML PLUS STERILE LATEX FREE|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|4200.00||||4200.00|1806|3780|882
100100|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SUBSTITUTE BONE GRAFT XEMPLIFI DEMINERALIZED BONE MATRIX 10 ML PLUS STERILE LATEX FREE|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|4200.00||||4200.00|1470|3780|882
100100|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SUBSTITUTE BONE GRAFT XEMPLIFI DEMINERALIZED BONE MATRIX 10 ML PLUS STERILE LATEX FREE|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|4200.00||||4200.00|3780|3780|882
100100|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SUBSTITUTE BONE GRAFT XEMPLIFI DEMINERALIZED BONE MATRIX 10 ML PLUS STERILE LATEX FREE|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|4200.00||||4200.00|2730|3780|882
100100|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SUBSTITUTE BONE GRAFT XEMPLIFI DEMINERALIZED BONE MATRIX 10 ML PLUS STERILE LATEX FREE|<Self-pay>|<Self-pay>|4200.00||||4200.00|1260|3780|882
100100|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SUBSTITUTE BONE GRAFT XEMPLIFI DEMINERALIZED BONE MATRIX 10 ML PLUS STERILE LATEX FREE|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|4200.00||||4200.00|1386|3780|882
100100|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SUBSTITUTE BONE GRAFT XEMPLIFI DEMINERALIZED BONE MATRIX 10 ML PLUS STERILE LATEX FREE|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|4200.00||||4200.00|3780|3780|882
100100|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SUBSTITUTE BONE GRAFT XEMPLIFI DEMINERALIZED BONE MATRIX 10 ML PLUS STERILE LATEX FREE|FIRST HEALTH [1375]|QUALCHOICE [137513]|4200.00||||4200.00|3780|3780|882
100100|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SUBSTITUTE BONE GRAFT XEMPLIFI DEMINERALIZED BONE MATRIX 10 ML PLUS STERILE LATEX FREE|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|4200.00||||4200.00|3780|3780|882
100100|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SUBSTITUTE BONE GRAFT XEMPLIFI DEMINERALIZED BONE MATRIX 10 ML PLUS STERILE LATEX FREE|HEALTHNET [1495]|HEALTHNET [149500]|4200.00||||4200.00|3780|3780|882
100100|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SUBSTITUTE BONE GRAFT XEMPLIFI DEMINERALIZED BONE MATRIX 10 ML PLUS STERILE LATEX FREE|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|4200.00||||4200.00|3780|3780|882
100100|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SUBSTITUTE BONE GRAFT XEMPLIFI DEMINERALIZED BONE MATRIX 10 ML PLUS STERILE LATEX FREE|FIRST HEALTH [1375]|BENVEO/UCS [137512]|4200.00||||4200.00|3570|3780|882
100100|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SUBSTITUTE BONE GRAFT XEMPLIFI DEMINERALIZED BONE MATRIX 10 ML PLUS STERILE LATEX FREE|GROUP PENSION ADMIN [1450]|GPA [145000]|4200.00||||4200.00|2940|3780|882
100100|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SUBSTITUTE BONE GRAFT XEMPLIFI DEMINERALIZED BONE MATRIX 10 ML PLUS STERILE LATEX FREE|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|4200.00||||4200.00|3780|3780|882
100100|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SUBSTITUTE BONE GRAFT XEMPLIFI DEMINERALIZED BONE MATRIX 10 ML PLUS STERILE LATEX FREE|SAMBA HEALTH [2305]|SAMBA HEALTH [230500]|4200.00||||4200.00|2940|3780|882
100100|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SUBSTITUTE BONE GRAFT XEMPLIFI DEMINERALIZED BONE MATRIX 10 ML PLUS STERILE LATEX FREE|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|4200.00||||4200.00|2730|3780|882
100100|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SUBSTITUTE BONE GRAFT XEMPLIFI DEMINERALIZED BONE MATRIX 10 ML PLUS STERILE LATEX FREE|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|4200.00||||4200.00|3780|3780|882
100100|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SUBSTITUTE BONE GRAFT XEMPLIFI DEMINERALIZED BONE MATRIX 10 ML PLUS STERILE LATEX FREE|TRUSTMARK [2030]|STARMARK [203000]|4200.00||||4200.00|3780|3780|882
100100|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SUBSTITUTE BONE GRAFT XEMPLIFI DEMINERALIZED BONE MATRIX 10 ML PLUS STERILE LATEX FREE|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|4200.00||||4200.00|3780|3780|882
100100|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SUBSTITUTE BONE GRAFT XEMPLIFI DEMINERALIZED BONE MATRIX 10 ML PLUS STERILE LATEX FREE|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|4200.00||||4200.00|2431.8|3780|882
100100|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SUBSTITUTE BONE GRAFT XEMPLIFI DEMINERALIZED BONE MATRIX 10 ML PLUS STERILE LATEX FREE|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|4200.00||||4200.00|3780|3780|882
100100|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SUBSTITUTE BONE GRAFT XEMPLIFI DEMINERALIZED BONE MATRIX 10 ML PLUS STERILE LATEX FREE|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|4200.00||||4200.00|2066.4|3780|882
100100|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SUBSTITUTE BONE GRAFT XEMPLIFI DEMINERALIZED BONE MATRIX 10 ML PLUS STERILE LATEX FREE|AETNA [1015]|AETNA ACO WILCO [101532]|4200.00||||4200.00|1470|3780|882
100100|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SUBSTITUTE BONE GRAFT XEMPLIFI DEMINERALIZED BONE MATRIX 10 ML PLUS STERILE LATEX FREE|AETNA [1015]|AMERICAN CONTINENTAL [101507]|4200.00||||4200.00|2940|3780|882
100100|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SUBSTITUTE BONE GRAFT XEMPLIFI DEMINERALIZED BONE MATRIX 10 ML PLUS STERILE LATEX FREE|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|4200.00||||4200.00|1701|3780|882
100100|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SUBSTITUTE BONE GRAFT XEMPLIFI DEMINERALIZED BONE MATRIX 10 ML PLUS STERILE LATEX FREE|AETNA [1015]|COVENTRY HEALTHCARE [101502]|4200.00||||4200.00|3780|3780|882
100100|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SUBSTITUTE BONE GRAFT XEMPLIFI DEMINERALIZED BONE MATRIX 10 ML PLUS STERILE LATEX FREE|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|4200.00||||4200.00|3780|3780|882
100100|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SUBSTITUTE BONE GRAFT XEMPLIFI DEMINERALIZED BONE MATRIX 10 ML PLUS STERILE LATEX FREE|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|4200.00||||4200.00|1470|3780|882
100100|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SUBSTITUTE BONE GRAFT XEMPLIFI DEMINERALIZED BONE MATRIX 10 ML PLUS STERILE LATEX FREE|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|4200.00||||4200.00|3234|3780|882
100100|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SUBSTITUTE BONE GRAFT XEMPLIFI DEMINERALIZED BONE MATRIX 10 ML PLUS STERILE LATEX FREE|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|4200.00||||4200.00|||
100100|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SUBSTITUTE BONE GRAFT XEMPLIFI DEMINERALIZED BONE MATRIX 10 ML PLUS STERILE LATEX FREE|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|4200.00||||4200.00|||
100100|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SUBSTITUTE BONE GRAFT XEMPLIFI DEMINERALIZED BONE MATRIX 10 ML PLUS STERILE LATEX FREE|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|4200.00||||4200.00|||
100100|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SUBSTITUTE BONE GRAFT XEMPLIFI DEMINERALIZED BONE MATRIX 10 ML PLUS STERILE LATEX FREE|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|4200.00||||4200.00|||
100100|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SUBSTITUTE BONE GRAFT XEMPLIFI DEMINERALIZED BONE MATRIX 10 ML PLUS STERILE LATEX FREE|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|4200.00||||4200.00|||
100100|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SUBSTITUTE BONE GRAFT XEMPLIFI DEMINERALIZED BONE MATRIX 10 ML PLUS STERILE LATEX FREE|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|4200.00||||4200.00|||
100100|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SUBSTITUTE BONE GRAFT XEMPLIFI DEMINERALIZED BONE MATRIX 10 ML PLUS STERILE LATEX FREE|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|4200.00||||4200.00|||
100100|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SUBSTITUTE BONE GRAFT XEMPLIFI DEMINERALIZED BONE MATRIX 10 ML PLUS STERILE LATEX FREE|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|4200.00||||4200.00|||
100100|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SUBSTITUTE BONE GRAFT XEMPLIFI DEMINERALIZED BONE MATRIX 10 ML PLUS STERILE LATEX FREE|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|4200.00||||4200.00|||
100100|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SUBSTITUTE BONE GRAFT XEMPLIFI DEMINERALIZED BONE MATRIX 10 ML PLUS STERILE LATEX FREE|CHAMPVA [1240]|CHAMP VA [124000]|4200.00||||4200.00|||
100100|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SUBSTITUTE BONE GRAFT XEMPLIFI DEMINERALIZED BONE MATRIX 10 ML PLUS STERILE LATEX FREE|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|4200.00||||4200.00|||
100100|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SUBSTITUTE BONE GRAFT XEMPLIFI DEMINERALIZED BONE MATRIX 10 ML PLUS STERILE LATEX FREE|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|4200.00||||4200.00|||
100100|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SUBSTITUTE BONE GRAFT XEMPLIFI DEMINERALIZED BONE MATRIX 10 ML PLUS STERILE LATEX FREE|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|4200.00||||4200.00|||
100100|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SUBSTITUTE BONE GRAFT XEMPLIFI DEMINERALIZED BONE MATRIX 10 ML PLUS STERILE LATEX FREE|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|4200.00||||4200.00|||
100100|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SUBSTITUTE BONE GRAFT XEMPLIFI DEMINERALIZED BONE MATRIX 10 ML PLUS STERILE LATEX FREE|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|4200.00||||4200.00|||
100100|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SUBSTITUTE BONE GRAFT XEMPLIFI DEMINERALIZED BONE MATRIX 10 ML PLUS STERILE LATEX FREE|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|4200.00||||4200.00|||
100100|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SUBSTITUTE BONE GRAFT XEMPLIFI DEMINERALIZED BONE MATRIX 10 ML PLUS STERILE LATEX FREE|GEHA [1415]|GEHA - ASA [141503]|4200.00||||4200.00|||
100100|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SUBSTITUTE BONE GRAFT XEMPLIFI DEMINERALIZED BONE MATRIX 10 ML PLUS STERILE LATEX FREE|UNITED HEALTHCARE [2060]|UHC MEDICA CHOICE [206030]|4200.00||||4200.00|||
100100|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SUBSTITUTE BONE GRAFT XEMPLIFI DEMINERALIZED BONE MATRIX 10 ML PLUS STERILE LATEX FREE|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|4200.00||||4200.00|||
100100|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SUBSTITUTE BONE GRAFT XEMPLIFI DEMINERALIZED BONE MATRIX 10 ML PLUS STERILE LATEX FREE|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|4200.00||||4200.00|||
100100|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SUBSTITUTE BONE GRAFT XEMPLIFI DEMINERALIZED BONE MATRIX 10 ML PLUS STERILE LATEX FREE|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|4200.00||||4200.00|||
100100|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SUBSTITUTE BONE GRAFT XEMPLIFI DEMINERALIZED BONE MATRIX 10 ML PLUS STERILE LATEX FREE|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|4200.00||||4200.00|||
100100|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SUBSTITUTE BONE GRAFT XEMPLIFI DEMINERALIZED BONE MATRIX 10 ML PLUS STERILE LATEX FREE|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|4200.00||||4200.00|||
100100|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SUBSTITUTE BONE GRAFT XEMPLIFI DEMINERALIZED BONE MATRIX 10 ML PLUS STERILE LATEX FREE|UMR [2035]|UMR OPTIONS [203501]|4200.00||||4200.00|||
100100|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SUBSTITUTE BONE GRAFT XEMPLIFI DEMINERALIZED BONE MATRIX 10 ML PLUS STERILE LATEX FREE|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|4200.00||||4200.00|||
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|10.00||||10.00|9|9|2.1
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|10.00||||10.00|9|9|2.1
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|10.00||||10.00|9|9|2.1
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|10.00||||10.00|9|9|2.1
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|10.00||||10.00|3.19|9|2.1
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|10.00||||10.00|3.19|9|2.1
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|10.00||||10.00|3.19|9|2.1
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|10.00||||10.00|9|9|2.1
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|10.00||||10.00|9|9|2.1
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|10.00||||10.00|9|9|2.1
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|HEALTHNET [1495]|HEALTHNET [149500]|10.00||||10.00|9|9|2.1
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|HEALTHNET [1495]|HEALTHNET [149500]|10.00||||10.00|9|9|2.1
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|HEALTHNET [1495]|HEALTHNET [149500]|10.00||||10.00|9|9|2.1
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|10.00||||10.00|9|9|2.1
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|10.00||||10.00|9|9|2.1
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|HEALTHNET [1495]|HEALTHNET [149500]|10.00||||10.00|9|9|2.1
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|10.00||||10.00|9|9|2.1
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|10.00||||10.00|9|9|2.1
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|10.00||||10.00|9|9|2.1
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|CIGNA [1260]|CIGNA - GREAT WEST [126009]|10.00||||10.00|7|9|2.1
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|CIGNA [1260]|CIGNA - GREAT WEST [126009]|10.00||||10.00|7|9|2.1
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|CIGNA [1260]|CIGNA - GREAT WEST [126009]|10.00||||10.00|7|9|2.1
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|FMH BENEFIT SERVICES [1390]|FMH [139000]|10.00||||10.00|9|9|2.1
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|FMH BENEFIT SERVICES [1390]|FMH [139000]|10.00||||10.00|9|9|2.1
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|FMH BENEFIT SERVICES [1390]|FMH [139000]|10.00||||10.00|9|9|2.1
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|FMH BENEFIT SERVICES [1390]|FMH [139000]|10.00||||10.00|9|9|2.1
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|10.00||||10.00|9|9|2.1
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|10.00||||10.00|9|9|2.1
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|10.00||||10.00|9|9|2.1
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|10.00||||10.00|3.3|9|2.1
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|10.00||||10.00|3.3|9|2.1
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|10.00||||10.00|3.3|9|2.1
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|10.00||||10.00|3.3|9|2.1
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|10.00||||10.00|2.1|9|2.1
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|10.00||||10.00|2.1|9|2.1
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|10.00||||10.00|2.1|9|2.1
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|10.00||||10.00|2.1|9|2.1
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|10.00||||10.00|2.1|9|2.1
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|10.00||||10.00|5|9|2.1
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|10.00||||10.00|5|9|2.1
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|FMH BENEFIT SERVICES [1390]|FMH [139000]|10.00||||10.00|9|9|2.1
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|10.00||||10.00|9|9|2.1
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|CIGNA [1260]|CIGNA - GREAT WEST [126009]|10.00||||10.00|7|9|2.1
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|10.00||||10.00|5|9|2.1
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|CIGNA [1260]|CIGNA - GREAT WEST [126009]|10.00||||10.00|7|9|2.1
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|10.00||||10.00|9|9|2.1
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|10.00||||10.00|3.3|9|2.1
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|10.00||||10.00|5|9|2.1
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|HEALTHNET [1495]|HEALTHNET [149500]|10.00||||10.00|9|9|2.1
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|10.00||||10.00|5|9|2.1
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|10.00||||10.00|9|9|2.1
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|10.00||||10.00|9|9|2.1
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|10.00||||10.00|9|9|2.1
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|10.00||||10.00|9|9|2.1
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|10.00||||10.00|9|9|2.1
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|10.00||||10.00|9|9|2.1
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|10.00||||10.00|9|9|2.1
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|10.00||||10.00|3.19|9|2.1
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|10.00||||10.00|7.7|9|2.1
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|10.00||||10.00|7.7|9|2.1
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|10.00||||10.00|3.19|9|2.1
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|10.00||||10.00|9|9|2.1
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|10.00||||10.00|7.7|9|2.1
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|10.00||||10.00|7.7|9|2.1
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|10.00||||10.00|7.7|9|2.1
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|10.00||||10.00|4.3|9|2.1
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|10.00||||10.00|4.3|9|2.1
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|10.00||||10.00|4.3|9|2.1
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|10.00||||10.00|4.3|9|2.1
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|10.00||||10.00|4.3|9|2.1
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|10.00||||10.00|||
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|10.00||||10.00|||
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|10.00||||10.00|||
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|10.00||||10.00|||
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|10.00||||10.00|||
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|10.00||||10.00|||
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|10.00||||10.00|||
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|10.00||||10.00|||
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|10.00||||10.00|||
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|10.00||||10.00|||
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|10.00||||10.00|||
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|10.00||||10.00|||
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|10.00||||10.00|||
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|10.00||||10.00|||
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|10.00||||10.00|||
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|10.00||||10.00|||
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|10.00||||10.00|||
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|10.00||||10.00|||
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|10.00||||10.00|||
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|10.00||||10.00|||
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|10.00||||10.00|||
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|10.00||||10.00|||
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|10.00||||10.00|||
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|10.00||||10.00|||
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|10.00||||10.00|||
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|10.00||||10.00|||
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|10.00||||10.00|||
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|10.00||||10.00|||
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|10.00||||10.00|||
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|10.00||||10.00|||
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|10.00||||10.00|||
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|10.00||||10.00|||
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|10.00||||10.00|||
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|10.00||||10.00|||
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|10.00||||10.00|||
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|10.00||||10.00|||
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|10.00||||10.00|||
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|10.00||||10.00|||
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|10.00||||10.00|||
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|10.00||||10.00|||
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|10.00||||10.00|||
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|10.00||||10.00|||
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|10.00||||10.00|||
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|10.00||||10.00|||
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|10.00||||10.00|||
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|10.00||||10.00|||
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|10.00||||10.00|||
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|10.00||||10.00|||
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|10.00||||10.00|||
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|10.00||||10.00|||
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|10.00||||10.00|||
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|10.00||||10.00|||
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|10.00||||10.00|||
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|10.00||||10.00|||
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|10.00||||10.00|||
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|10.00||||10.00|||
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|SAMBA HEALTH [2305]|SAMBA HEALTH [230500]|10.00||||10.00|7|9|2.1
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|SAMBA HEALTH [2305]|SAMBA HEALTH [230500]|10.00||||10.00|7|9|2.1
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|SAMBA HEALTH [2305]|SAMBA HEALTH [230500]|10.00||||10.00|7|9|2.1
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|SAMBA HEALTH [2305]|SAMBA HEALTH [230500]|10.00||||10.00|7|9|2.1
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|10.00||||10.00|9|9|2.1
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|10.00||||10.00|9|9|2.1
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|10.00||||10.00|9|9|2.1
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|10.00||||10.00|9|9|2.1
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|10.00||||10.00|9|9|2.1
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|MULTIPLAN [1680]|IHC HS [168011]|10.00||||10.00|9|9|2.1
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|MULTIPLAN [1680]|IHC HS [168011]|10.00||||10.00|9|9|2.1
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|MULTIPLAN [1680]|IHC HS [168011]|10.00||||10.00|9|9|2.1
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|MULTIPLAN [1680]|IHC HS [168011]|10.00||||10.00|9|9|2.1
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|10.00||||10.00|9|9|2.1
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|10.00||||10.00|9|9|2.1
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|10.00||||10.00|9|9|2.1
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|10.00||||10.00|9|9|2.1
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|10.00||||10.00|9|9|2.1
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|10.00||||10.00|9|9|2.1
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|10.00||||10.00|9|9|2.1
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|10.00||||10.00|9|9|2.1
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|TRUSTMARK [2030]|STARMARK [203000]|10.00||||10.00|9|9|2.1
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|TRUSTMARK [2030]|STARMARK [203000]|10.00||||10.00|9|9|2.1
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|TRUSTMARK [2030]|STARMARK [203000]|10.00||||10.00|9|9|2.1
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|TRUSTMARK [2030]|STARMARK [203000]|10.00||||10.00|9|9|2.1
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|10.00||||10.00|9|9|2.1
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|10.00||||10.00|9|9|2.1
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|10.00||||10.00|9|9|2.1
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|10.00||||10.00|9|9|2.1
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|GROUP PENSION ADMIN [1450]|GPA [145000]|10.00||||10.00|7|9|2.1
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|GROUP PENSION ADMIN [1450]|GPA [145000]|10.00||||10.00|7|9|2.1
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|GROUP PENSION ADMIN [1450]|GPA [145000]|10.00||||10.00|7|9|2.1
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|FIRST HEALTH [1375]|QUALCHOICE [137513]|10.00||||10.00|9|9|2.1
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|FIRST HEALTH [1375]|BENVEO/UCS [137512]|10.00||||10.00|8.5|9|2.1
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|FIRST HEALTH [1375]|BENVEO/UCS [137512]|10.00||||10.00|8.5|9|2.1
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|FIRST HEALTH [1375]|QUALCHOICE [137513]|10.00||||10.00|9|9|2.1
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|FIRST HEALTH [1375]|QUALCHOICE [137513]|10.00||||10.00|9|9|2.1
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|FIRST HEALTH [1375]|BENVEO/UCS [137512]|10.00||||10.00|8.5|9|2.1
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|FIRST HEALTH [1375]|QUALCHOICE [137513]|10.00||||10.00|9|9|2.1
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|FIRST HEALTH [1375]|BENVEO/UCS [137512]|10.00||||10.00|8.5|9|2.1
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|FIRST HEALTH [1375]|BENVEO/UCS [137512]|10.00||||10.00|8.5|9|2.1
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|<Self-pay>|<Self-pay>|10.00||||10.00|3|9|2.1
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|<Self-pay>|<Self-pay>|10.00||||10.00|3|9|2.1
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|<Self-pay>|<Self-pay>|10.00||||10.00|3|9|2.1
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|<Self-pay>|<Self-pay>|10.00||||10.00|3|9|2.1
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|<Self-pay>|<Self-pay>|10.00||||10.00|3|9|2.1
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|10.00||||10.00|9|9|2.1
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|10.00||||10.00|9|9|2.1
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|10.00||||10.00|9|9|2.1
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|10.00||||10.00|9|9|2.1
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|10.00||||10.00|6.5|9|2.1
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|10.00||||10.00|6.5|9|2.1
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|10.00||||10.00|6.5|9|2.1
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|10.00||||10.00|6.5|9|2.1
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|10.00||||10.00|6.5|9|2.1
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|10.00||||10.00|6.5|9|2.1
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|10.00||||10.00|6.5|9|2.1
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|10.00||||10.00|6.5|9|2.1
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|10.00||||10.00|6.5|9|2.1
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|10.00||||10.00|6.5|9|2.1
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|10.00||||10.00|9|9|2.1
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|10.00||||10.00|9|9|2.1
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|10.00||||10.00|9|9|2.1
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|10.00||||10.00|9|9|2.1
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|10.00||||10.00|9|9|2.1
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|10.00||||10.00|9|9|2.1
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|AETNA [1015]|AMERICAN CONTINENTAL [101507]|10.00||||10.00|7|9|2.1
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|AETNA [1015]|AMERICAN CONTINENTAL [101507]|10.00||||10.00|7|9|2.1
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|AETNA [1015]|AMERICAN CONTINENTAL [101507]|10.00||||10.00|7|9|2.1
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|AETNA [1015]|COVENTRY HEALTHCARE [101502]|10.00||||10.00|9|9|2.1
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|AETNA [1015]|AMERICAN CONTINENTAL [101507]|10.00||||10.00|7|9|2.1
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|AETNA [1015]|AMERICAN CONTINENTAL [101507]|10.00||||10.00|7|9|2.1
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|AETNA [1015]|COVENTRY HEALTHCARE [101502]|10.00||||10.00|9|9|2.1
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|10.00||||10.00|||
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|10.00||||10.00|||
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|10.00||||10.00|||
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|10.00||||10.00|||
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|10.00||||10.00|||
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|10.00||||10.00|||
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|10.00||||10.00|||
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|UMR [2035]|UMR OPTIONS [203501]|10.00||||10.00|||
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|UMR [2035]|UMR OPTIONS [203501]|10.00||||10.00|||
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|UMR [2035]|UMR OPTIONS [203501]|10.00||||10.00|||
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|UMR [2035]|UMR OPTIONS [203501]|10.00||||10.00|||
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|10.00||||10.00|||
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|10.00||||10.00|||
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|MULTIPLAN [1680]|HMA [168003]|10.00||||10.00|||
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|MULTIPLAN [1680]|HMA [168003]|10.00||||10.00|||
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|10.00||||10.00|||
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|10.00||||10.00|||
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|MULTIPLAN [1680]|HMA [168003]|10.00||||10.00|||
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|MULTIPLAN [1680]|HMA [168003]|10.00||||10.00|||
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|10.00||||10.00|||
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|10.00||||10.00|||
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|10.00||||10.00|||
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|10.00||||10.00|||
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|10.00||||10.00|||
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|10.00||||10.00|||
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|10.00||||10.00|||
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|10.00||||10.00|||
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|10.00||||10.00|||
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|10.00||||10.00|||
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|10.00||||10.00|||
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|10.00||||10.00|||
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|10.00||||10.00|||
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|10.00||||10.00|||
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|10.00||||10.00|||
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|10.00||||10.00|||
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|UNITED HEALTHCARE [2060]|UHC MEDICA CHOICE [206030]|10.00||||10.00|||
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|UNITED HEALTHCARE [2060]|UHC MEDICA CHOICE [206030]|10.00||||10.00|||
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|UNITED HEALTHCARE [2060]|UHC MEDICA CHOICE [206030]|10.00||||10.00|||
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|UNITED HEALTHCARE [2060]|UHC MEDICA CHOICE [206030]|10.00||||10.00|||
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|GEHA [1415]|GEHA - ASA [141503]|10.00||||10.00|||
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|GEHA [1415]|GEHA - ASA [141503]|10.00||||10.00|||
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|GEHA [1415]|GEHA - ASA [141503]|10.00||||10.00|||
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|GEHA [1415]|GEHA - ASA [141503]|10.00||||10.00|||
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|10.00||||10.00|||
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|10.00||||10.00|||
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|10.00||||10.00|||
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|10.00||||10.00|||
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|10.00||||10.00|||
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|10.00||||10.00|||
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|AETNA [1015]|AETNA ACO WILCO [101532]|10.00||||10.00|||
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|GEHA [1415]|GEHA - ASA [141503]|10.00||||10.00|||
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|10.00||||10.00|||
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|UNITED HEALTHCARE [2060]|UHC MEDICA CHOICE [206030]|10.00||||10.00|||
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|AETNA [1015]|COVENTRY HEALTHCARE [101502]|10.00||||10.00|9|9|2.1
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|AETNA [1015]|COVENTRY HEALTHCARE [101502]|10.00||||10.00|9|9|2.1
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|FIRST HEALTH [1375]|QUALCHOICE [137513]|10.00||||10.00|9|9|2.1
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|AETNA [1015]|COVENTRY HEALTHCARE [101502]|10.00||||10.00|9|9|2.1
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|10.00||||10.00|9|9|2.1
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|10.00||||10.00|9|9|2.1
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|10.00||||10.00|9|9|2.1
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|10.00||||10.00|9|9|2.1
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|10.00||||10.00|9|9|2.1
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|10.00||||10.00|4.3|9|2.1
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|10.00||||10.00|4.92|9|2.1
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|10.00||||10.00|5.79|9|2.1
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|10.00||||10.00|4.3|9|2.1
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|10.00||||10.00|4.92|9|2.1
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|10.00||||10.00|4.05|9|2.1
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|GROUP PENSION ADMIN [1450]|GPA [145000]|10.00||||10.00|7|9|2.1
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|GROUP PENSION ADMIN [1450]|GPA [145000]|10.00||||10.00|7|9|2.1
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|10.00||||10.00|4.92|9|2.1
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|10.00||||10.00|4.05|9|2.1
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|10.00||||10.00|4.05|9|2.1
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|10.00||||10.00|4.3|9|2.1
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|10.00||||10.00|4.3|9|2.1
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|10.00||||10.00|5.79|9|2.1
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|10.00||||10.00|4.05|9|2.1
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|10.00||||10.00|5.79|9|2.1
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|10.00||||10.00|9|9|2.1
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|10.00||||10.00|5.79|9|2.1
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|10.00||||10.00|4.05|9|2.1
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|TRUSTMARK [2030]|STARMARK [203000]|10.00||||10.00|9|9|2.1
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|10.00||||10.00|5.79|9|2.1
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|10.00||||10.00|4.3|9|2.1
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|10.00||||10.00|4.92|9|2.1
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|10.00||||10.00|4.92|9|2.1
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|10.00||||10.00|9|9|2.1
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|10.00||||10.00|9|9|2.1
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|10.00||||10.00|9|9|2.1
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|10.00||||10.00|9|9|2.1
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|10.00||||10.00|9|9|2.1
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|10.00||||10.00|9|9|2.1
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|10.00||||10.00|9|9|2.1
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|10.00||||10.00|9|9|2.1
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|10.00||||10.00|9|9|2.1
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|10.00||||10.00|9|9|2.1
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|MULTIPLAN [1680]|IHC HS [168011]|10.00||||10.00|9|9|2.1
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|10.00||||10.00|9|9|2.1
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|10.00||||10.00|9|9|2.1
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|10.00||||10.00|6.5|9|2.1
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|10.00||||10.00|6.5|9|2.1
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|10.00||||10.00|6.5|9|2.1
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|10.00||||10.00|6.5|9|2.1
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|10.00||||10.00|6.5|9|2.1
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|SAMBA HEALTH [2305]|SAMBA HEALTH [230500]|10.00||||10.00|7|9|2.1
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|10.00||||10.00|9|9|2.1
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|10.00||||10.00|9|9|2.1
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|10.00||||10.00|9|9|2.1
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|10.00||||10.00|9|9|2.1
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|10.00||||10.00|9|9|2.1
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|CORESOURCE [1315]|CORESOURCE [131500]|10.00||||10.00|9|9|2.1
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|CORESOURCE [1315]|CORESOURCE [131500]|10.00||||10.00|9|9|2.1
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|CORESOURCE [1315]|CORESOURCE [131500]|10.00||||10.00|9|9|2.1
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|CORESOURCE [1315]|CORESOURCE [131500]|10.00||||10.00|9|9|2.1
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|CORESOURCE [1315]|CORESOURCE [131500]|10.00||||10.00|9|9|2.1
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|10.00||||10.00|||
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|AETNA [1015]|AETNA ACO WILCO [101532]|10.00||||10.00|||
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|10.00||||10.00|||
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|AETNA [1015]|AETNA ACO WILCO [101532]|10.00||||10.00|||
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|10.00||||10.00|||
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|10.00||||10.00|||
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|10.00||||10.00|||
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|AETNA [1015]|AETNA ACO WILCO [101532]|10.00||||10.00|||
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|AETNA [1015]|AETNA ACO WILCO [101532]|10.00||||10.00|||
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|10.00||||10.00|||
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|10.00||||10.00|||
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|10.00||||10.00|||
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|10.00||||10.00|||
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|10.00||||10.00|||
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|10.00||||10.00|||
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|10.00||||10.00|||
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|10.00||||10.00|||
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|10.00||||10.00|||
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|10.00||||10.00|||
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|10.00||||10.00|||
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|10.00||||10.00|||
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|MULTIPLAN [1680]|HMA [168003]|10.00||||10.00|||
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|10.00||||10.00|||
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|10.00||||10.00|||
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|UMR [2035]|UMR OPTIONS [203501]|10.00||||10.00|||
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|10.00||||10.00|||
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|10.00||||10.00|||
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|10.00||||10.00|||
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|10.00||||10.00|||
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|10.00||||10.00|||
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|10.00||||10.00|||
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|10.00||||10.00|||
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|10.00||||10.00|||
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|10.00||||10.00|||
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|10.00||||10.00|||
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|10.00||||10.00|||
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|CHAMPVA [1240]|CHAMP VA [124000]|10.00||||10.00|||
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|CHAMPVA [1240]|CHAMP VA [124000]|10.00||||10.00|||
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|CHAMPVA [1240]|CHAMP VA [124000]|10.00||||10.00|||
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|CHAMPVA [1240]|CHAMP VA [124000]|10.00||||10.00|||
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|CHAMPVA [1240]|CHAMP VA [124000]|10.00||||10.00|||
100110|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SLEEVE TIBIAL KNEE MODULAR ROTATE HINGE|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|1826.40||||1826.40|785.35|1643.76|383.54
100110|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SLEEVE TIBIAL KNEE MODULAR ROTATE HINGE|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|1826.40||||1826.40|1406.33|1643.76|383.54
100110|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SLEEVE TIBIAL KNEE MODULAR ROTATE HINGE|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|1826.40||||1826.40|913.2|1643.76|383.54
100110|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SLEEVE TIBIAL KNEE MODULAR ROTATE HINGE|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|1826.40||||1826.40|1643.76|1643.76|383.54
100110|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SLEEVE TIBIAL KNEE MODULAR ROTATE HINGE|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|1826.40||||1826.40|913.2|1643.76|383.54
100110|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SLEEVE TIBIAL KNEE MODULAR ROTATE HINGE|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|1826.40||||1826.40|383.54|1643.76|383.54
100110|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SLEEVE TIBIAL KNEE MODULAR ROTATE HINGE|FMH BENEFIT SERVICES [1390]|FMH [139000]|1826.40||||1826.40|1643.76|1643.76|383.54
100110|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SLEEVE TIBIAL KNEE MODULAR ROTATE HINGE|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|1826.40||||1826.40|1643.76|1643.76|383.54
100110|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SLEEVE TIBIAL KNEE MODULAR ROTATE HINGE|CIGNA [1260]|CIGNA - GREAT WEST [126009]|1826.40||||1826.40|1278.48|1643.76|383.54
100110|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SLEEVE TIBIAL KNEE MODULAR ROTATE HINGE|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|1826.40||||1826.40|1643.76|1643.76|383.54
100110|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SLEEVE TIBIAL KNEE MODULAR ROTATE HINGE|HEALTHNET [1495]|HEALTHNET [149500]|1826.40||||1826.40|1643.76|1643.76|383.54
100110|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SLEEVE TIBIAL KNEE MODULAR ROTATE HINGE|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|1826.40||||1826.40|582.62|1643.76|383.54
100110|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SLEEVE TIBIAL KNEE MODULAR ROTATE HINGE|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|1826.40||||1826.40|1643.76|1643.76|383.54
100110|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SLEEVE TIBIAL KNEE MODULAR ROTATE HINGE|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|1826.40||||1826.40|1643.76|1643.76|383.54
100110|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SLEEVE TIBIAL KNEE MODULAR ROTATE HINGE|CORESOURCE [1315]|CORESOURCE [131500]|1826.40||||1826.40|1643.76|1643.76|383.54
100110|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SLEEVE TIBIAL KNEE MODULAR ROTATE HINGE|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|1826.40||||1826.40|639.24|1643.76|383.54
100110|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SLEEVE TIBIAL KNEE MODULAR ROTATE HINGE|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|1826.40||||1826.40|1187.16|1643.76|383.54
100110|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SLEEVE TIBIAL KNEE MODULAR ROTATE HINGE|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|1826.40||||1826.40|1643.76|1643.76|383.54
100110|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SLEEVE TIBIAL KNEE MODULAR ROTATE HINGE|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|1826.40||||1826.40|1643.76|1643.76|383.54
100110|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SLEEVE TIBIAL KNEE MODULAR ROTATE HINGE|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|1826.40||||1826.40|739.69|1643.76|383.54
100110|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SLEEVE TIBIAL KNEE MODULAR ROTATE HINGE|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|1826.40||||1826.40|785.35|1643.76|383.54
100110|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SLEEVE TIBIAL KNEE MODULAR ROTATE HINGE|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|1826.40||||1826.40|898.59|1643.76|383.54
100110|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SLEEVE TIBIAL KNEE MODULAR ROTATE HINGE|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|1826.40||||1826.40|1057.49|1643.76|383.54
100110|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SLEEVE TIBIAL KNEE MODULAR ROTATE HINGE|AETNA [1015]|COVENTRY HEALTHCARE [101502]|1826.40||||1826.40|1643.76|1643.76|383.54
100110|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SLEEVE TIBIAL KNEE MODULAR ROTATE HINGE|AETNA [1015]|AMERICAN CONTINENTAL [101507]|1826.40||||1826.40|1278.48|1643.76|383.54
100110|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SLEEVE TIBIAL KNEE MODULAR ROTATE HINGE|AETNA [1015]|AETNA ACO WILCO [101532]|1826.40||||1826.40|639.24|1643.76|383.54
100110|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SLEEVE TIBIAL KNEE MODULAR ROTATE HINGE|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|1826.40||||1826.40|1643.76|1643.76|383.54
100110|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SLEEVE TIBIAL KNEE MODULAR ROTATE HINGE|MULTIPLAN [1680]|HMA [168003]|1826.40||||1826.40|639.24|1643.76|383.54
100110|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SLEEVE TIBIAL KNEE MODULAR ROTATE HINGE|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|1826.40||||1826.40|639.24|1643.76|383.54
100110|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SLEEVE TIBIAL KNEE MODULAR ROTATE HINGE|MULTIPLAN [1680]|IHC HS [168011]|1826.40||||1826.40|1643.76|1643.76|383.54
100110|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SLEEVE TIBIAL KNEE MODULAR ROTATE HINGE|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|1826.40||||1826.40|1643.76|1643.76|383.54
100110|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SLEEVE TIBIAL KNEE MODULAR ROTATE HINGE|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|1826.40||||1826.40|1643.76|1643.76|383.54
100110|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SLEEVE TIBIAL KNEE MODULAR ROTATE HINGE|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|1826.40||||1826.40|602.71|1643.76|383.54
100110|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SLEEVE TIBIAL KNEE MODULAR ROTATE HINGE|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|1826.40||||1826.40|1187.16|1643.76|383.54
100110|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SLEEVE TIBIAL KNEE MODULAR ROTATE HINGE|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|1826.40||||1826.40|1187.16|1643.76|383.54
100110|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SLEEVE TIBIAL KNEE MODULAR ROTATE HINGE|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|1826.40||||1826.40|1643.76|1643.76|383.54
100110|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SLEEVE TIBIAL KNEE MODULAR ROTATE HINGE|<Self-pay>|<Self-pay>|1826.40||||1826.40|547.92|1643.76|383.54
100110|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SLEEVE TIBIAL KNEE MODULAR ROTATE HINGE|FIRST HEALTH [1375]|BENVEO/UCS [137512]|1826.40||||1826.40|1552.44|1643.76|383.54
100110|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SLEEVE TIBIAL KNEE MODULAR ROTATE HINGE|FIRST HEALTH [1375]|QUALCHOICE [137513]|1826.40||||1826.40|1643.76|1643.76|383.54
100110|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SLEEVE TIBIAL KNEE MODULAR ROTATE HINGE|GROUP PENSION ADMIN [1450]|GPA [145000]|1826.40||||1826.40|1278.48|1643.76|383.54
100110|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SLEEVE TIBIAL KNEE MODULAR ROTATE HINGE|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|1826.40||||1826.40|1643.76|1643.76|383.54
100110|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SLEEVE TIBIAL KNEE MODULAR ROTATE HINGE|TRUSTMARK [2030]|STARMARK [203000]|1826.40||||1826.40|1643.76|1643.76|383.54
100110|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SLEEVE TIBIAL KNEE MODULAR ROTATE HINGE|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|1826.40||||1826.40|1643.76|1643.76|383.54
100110|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SLEEVE TIBIAL KNEE MODULAR ROTATE HINGE|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|1826.40||||1826.40|1643.76|1643.76|383.54
100110|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SLEEVE TIBIAL KNEE MODULAR ROTATE HINGE|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|1826.40||||1826.40|1643.76|1643.76|383.54
100110|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SLEEVE TIBIAL KNEE MODULAR ROTATE HINGE|SAMBA HEALTH [2305]|SAMBA HEALTH [230500]|1826.40||||1826.40|1278.48|1643.76|383.54
100110|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SLEEVE TIBIAL KNEE MODULAR ROTATE HINGE|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|1826.40||||1826.40|||
100110|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SLEEVE TIBIAL KNEE MODULAR ROTATE HINGE|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|1826.40||||1826.40|||
100110|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SLEEVE TIBIAL KNEE MODULAR ROTATE HINGE|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|1826.40||||1826.40|||
100110|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SLEEVE TIBIAL KNEE MODULAR ROTATE HINGE|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|1826.40||||1826.40|||
100110|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SLEEVE TIBIAL KNEE MODULAR ROTATE HINGE|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|1826.40||||1826.40|||
100110|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SLEEVE TIBIAL KNEE MODULAR ROTATE HINGE|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|1826.40||||1826.40|||
100110|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SLEEVE TIBIAL KNEE MODULAR ROTATE HINGE|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|1826.40||||1826.40|||
100110|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SLEEVE TIBIAL KNEE MODULAR ROTATE HINGE|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|1826.40||||1826.40|||
100110|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SLEEVE TIBIAL KNEE MODULAR ROTATE HINGE|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|1826.40||||1826.40|||
100110|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SLEEVE TIBIAL KNEE MODULAR ROTATE HINGE|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|1826.40||||1826.40|||
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]|1826.40||||1826.40|||
100110|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SLEEVE TIBIAL KNEE MODULAR ROTATE HINGE|CHAMPVA [1240]|CHAMP VA [124000]|1826.40||||1826.40|||
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]|1826.40||||1826.40|||
100110|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SLEEVE TIBIAL KNEE MODULAR ROTATE HINGE|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|1826.40||||1826.40|||
100110|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SLEEVE TIBIAL KNEE MODULAR ROTATE HINGE|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|1826.40||||1826.40|||
100110|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SLEEVE TIBIAL KNEE MODULAR ROTATE HINGE|GEHA [1415]|GEHA - ASA [141503]|1826.40||||1826.40|||
100110|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SLEEVE TIBIAL KNEE MODULAR ROTATE HINGE|UNITED HEALTHCARE [2060]|UHC MEDICA CHOICE [206030]|1826.40||||1826.40|||
100110|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SLEEVE TIBIAL KNEE MODULAR ROTATE HINGE|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|1826.40||||1826.40|||
100110|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SLEEVE TIBIAL KNEE MODULAR ROTATE HINGE|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|1826.40||||1826.40|||
100110|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SLEEVE TIBIAL KNEE MODULAR ROTATE HINGE|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|1826.40||||1826.40|||
100110|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SLEEVE TIBIAL KNEE MODULAR ROTATE HINGE|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|1826.40||||1826.40|||
100110|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SLEEVE TIBIAL KNEE MODULAR ROTATE HINGE|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|1826.40||||1826.40|||
100110|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SLEEVE TIBIAL KNEE MODULAR ROTATE HINGE|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|1826.40||||1826.40|||
100110|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SLEEVE TIBIAL KNEE MODULAR ROTATE HINGE|UMR [2035]|UMR OPTIONS [203501]|1826.40||||1826.40|||
100110|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SLEEVE TIBIAL KNEE MODULAR ROTATE HINGE|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|1826.40||||1826.40|||
10014|ERX|0250 - PHARMACY-GENERAL|FAT EMULSION 20 % INTRAVENOUS|SAMBA HEALTH [2305]|SAMBA HEALTH [230500]|406.98||||406.98|284.89|413.95|85.47
10014|ERX|0250 - PHARMACY-GENERAL|FAT EMULSION 20 % INTRAVENOUS|SAMBA HEALTH [2305]|SAMBA HEALTH [230500]|459.94||||459.94|321.96|413.95|85.47
10014|ERX|0250 - PHARMACY-GENERAL|FAT EMULSION 20 % INTRAVENOUS|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|406.98||||406.98|366.28|413.95|85.47
10014|ERX|0250 - PHARMACY-GENERAL|FAT EMULSION 20 % INTRAVENOUS|MULTIPLAN [1680]|IHC HS [168011]|406.98||||406.98|366.28|413.95|85.47
10014|ERX|0250 - PHARMACY-GENERAL|FAT EMULSION 20 % INTRAVENOUS|MULTIPLAN [1680]|IHC HS [168011]|459.94||||459.94|413.95|413.95|85.47
10014|ERX|0250 - PHARMACY-GENERAL|FAT EMULSION 20 % INTRAVENOUS|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|459.94||||459.94|413.95|413.95|85.47
10014|ERX|0250 - PHARMACY-GENERAL|FAT EMULSION 20 % INTRAVENOUS|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|459.94||||459.94|413.95|413.95|85.47
10014|ERX|0250 - PHARMACY-GENERAL|FAT EMULSION 20 % INTRAVENOUS|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|406.98||||406.98|366.28|413.95|85.47
10014|ERX|0250 - PHARMACY-GENERAL|FAT EMULSION 20 % INTRAVENOUS|TRUSTMARK [2030]|STARMARK [203000]|406.98||||406.98|366.28|413.95|85.47
10014|ERX|0250 - PHARMACY-GENERAL|FAT EMULSION 20 % INTRAVENOUS|TRUSTMARK [2030]|STARMARK [203000]|459.94||||459.94|413.95|413.95|85.47
10014|ERX|0250 - PHARMACY-GENERAL|FAT EMULSION 20 % INTRAVENOUS|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|406.98||||406.98|366.28|413.95|85.47
10014|ERX|0250 - PHARMACY-GENERAL|FAT EMULSION 20 % INTRAVENOUS|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|459.94||||459.94|413.95|413.95|85.47
10014|ERX|0250 - PHARMACY-GENERAL|FAT EMULSION 20 % INTRAVENOUS|GROUP PENSION ADMIN [1450]|GPA [145000]|459.94||||459.94|321.96|413.95|85.47
10014|ERX|0250 - PHARMACY-GENERAL|FAT EMULSION 20 % INTRAVENOUS|FIRST HEALTH [1375]|QUALCHOICE [137513]|459.94||||459.94|413.95|413.95|85.47
10014|ERX|0250 - PHARMACY-GENERAL|FAT EMULSION 20 % INTRAVENOUS|FIRST HEALTH [1375]|BENVEO/UCS [137512]|459.94||||459.94|390.95|413.95|85.47
10014|ERX|0250 - PHARMACY-GENERAL|FAT EMULSION 20 % INTRAVENOUS|FIRST HEALTH [1375]|QUALCHOICE [137513]|406.98||||406.98|366.28|413.95|85.47
10014|ERX|0250 - PHARMACY-GENERAL|FAT EMULSION 20 % INTRAVENOUS|<Self-pay>|<Self-pay>|459.94||||459.94|137.98|413.95|85.47
10014|ERX|0250 - PHARMACY-GENERAL|FAT EMULSION 20 % INTRAVENOUS|<Self-pay>|<Self-pay>|406.98||||406.98|122.09|413.95|85.47
10014|ERX|0250 - PHARMACY-GENERAL|FAT EMULSION 20 % INTRAVENOUS|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|406.98||||406.98|366.28|413.95|85.47
10014|ERX|0250 - PHARMACY-GENERAL|FAT EMULSION 20 % INTRAVENOUS|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|406.98||||406.98|264.54|413.95|85.47
10014|ERX|0250 - PHARMACY-GENERAL|FAT EMULSION 20 % INTRAVENOUS|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|459.94||||459.94|298.96|413.95|85.47
10014|ERX|0250 - PHARMACY-GENERAL|FAT EMULSION 20 % INTRAVENOUS|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|406.98||||406.98|264.54|413.95|85.47
10014|ERX|0250 - PHARMACY-GENERAL|FAT EMULSION 20 % INTRAVENOUS|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|459.94||||459.94|413.95|413.95|85.47
10014|ERX|0250 - PHARMACY-GENERAL|FAT EMULSION 20 % INTRAVENOUS|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|406.98||||406.98|366.28|413.95|85.47
10014|ERX|0250 - PHARMACY-GENERAL|FAT EMULSION 20 % INTRAVENOUS|AETNA [1015]|AMERICAN CONTINENTAL [101507]|406.98||||406.98|284.89|413.95|85.47
10014|ERX|0250 - PHARMACY-GENERAL|FAT EMULSION 20 % INTRAVENOUS|AETNA [1015]|COVENTRY HEALTHCARE [101502]|406.98||||406.98|366.28|413.95|85.47
10014|ERX|0250 - PHARMACY-GENERAL|FAT EMULSION 20 % INTRAVENOUS|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|459.94||||459.94|413.95|413.95|85.47
10014|ERX|0250 - PHARMACY-GENERAL|FAT EMULSION 20 % INTRAVENOUS|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|406.98||||406.98|366.28|413.95|85.47
10014|ERX|0250 - PHARMACY-GENERAL|FAT EMULSION 20 % INTRAVENOUS|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|406.98||||406.98|235.64|413.95|85.47
10014|ERX|0250 - PHARMACY-GENERAL|FAT EMULSION 20 % INTRAVENOUS|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|459.94||||459.94|197.77|413.95|85.47
10014|ERX|0250 - PHARMACY-GENERAL|FAT EMULSION 20 % INTRAVENOUS|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|406.98||||406.98|164.83|413.95|85.47
10014|ERX|0250 - PHARMACY-GENERAL|FAT EMULSION 20 % INTRAVENOUS|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|459.94||||459.94|266.31|413.95|85.47
10014|ERX|0250 - PHARMACY-GENERAL|FAT EMULSION 20 % INTRAVENOUS|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|459.94||||459.94|186.28|413.95|85.47
10014|ERX|0250 - PHARMACY-GENERAL|FAT EMULSION 20 % INTRAVENOUS|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|406.98||||406.98|200.23|413.95|85.47
10014|ERX|0250 - PHARMACY-GENERAL|FAT EMULSION 20 % INTRAVENOUS|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|406.98||||406.98|175|413.95|85.47
10014|ERX|0250 - PHARMACY-GENERAL|FAT EMULSION 20 % INTRAVENOUS|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|406.98||||406.98|366.28|413.95|85.47
10014|ERX|0250 - PHARMACY-GENERAL|FAT EMULSION 20 % INTRAVENOUS|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|459.94||||459.94|413.95|413.95|85.47
10014|ERX|0250 - PHARMACY-GENERAL|FAT EMULSION 20 % INTRAVENOUS|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|459.94||||459.94|413.95|413.95|85.47
10014|ERX|0250 - PHARMACY-GENERAL|FAT EMULSION 20 % INTRAVENOUS|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|406.98||||406.98|366.28|413.95|85.47
10014|ERX|0250 - PHARMACY-GENERAL|FAT EMULSION 20 % INTRAVENOUS|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|406.98||||406.98|264.54|413.95|85.47
10014|ERX|0250 - PHARMACY-GENERAL|FAT EMULSION 20 % INTRAVENOUS|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|459.94||||459.94|298.96|413.95|85.47
10014|ERX|0250 - PHARMACY-GENERAL|FAT EMULSION 20 % INTRAVENOUS|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|459.94||||459.94|226.29|413.95|85.47
10014|ERX|0250 - PHARMACY-GENERAL|FAT EMULSION 20 % INTRAVENOUS|AETNA [1015]|AMERICAN CONTINENTAL [101507]|459.94||||459.94|321.96|413.95|85.47
10014|ERX|0250 - PHARMACY-GENERAL|FAT EMULSION 20 % INTRAVENOUS|AETNA [1015]|COVENTRY HEALTHCARE [101502]|459.94||||459.94|413.95|413.95|85.47
10014|ERX|0250 - PHARMACY-GENERAL|FAT EMULSION 20 % INTRAVENOUS|CORESOURCE [1315]|CORESOURCE [131500]|459.94||||459.94|413.95|413.95|85.47
10014|ERX|0250 - PHARMACY-GENERAL|FAT EMULSION 20 % INTRAVENOUS|CORESOURCE [1315]|CORESOURCE [131500]|406.98||||406.98|366.28|413.95|85.47
10014|ERX|0250 - PHARMACY-GENERAL|FAT EMULSION 20 % INTRAVENOUS|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|406.98||||406.98|366.28|413.95|85.47
10014|ERX|0250 - PHARMACY-GENERAL|FAT EMULSION 20 % INTRAVENOUS|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|459.94||||459.94|413.95|413.95|85.47
10014|ERX|0250 - PHARMACY-GENERAL|FAT EMULSION 20 % INTRAVENOUS|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|459.94||||459.94|298.96|413.95|85.47
10014|ERX|0250 - PHARMACY-GENERAL|FAT EMULSION 20 % INTRAVENOUS|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|459.94||||459.94|413.95|413.95|85.47
10014|ERX|0250 - PHARMACY-GENERAL|FAT EMULSION 20 % INTRAVENOUS|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|459.94||||459.94|413.95|413.95|85.47
10014|ERX|0250 - PHARMACY-GENERAL|FAT EMULSION 20 % INTRAVENOUS|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|406.98||||406.98|366.28|413.95|85.47
10014|ERX|0250 - PHARMACY-GENERAL|FAT EMULSION 20 % INTRAVENOUS|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|406.98||||406.98|129.83|413.95|85.47
10014|ERX|0250 - PHARMACY-GENERAL|FAT EMULSION 20 % INTRAVENOUS|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|459.94||||459.94|146.72|413.95|85.47
10014|ERX|0250 - PHARMACY-GENERAL|FAT EMULSION 20 % INTRAVENOUS|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|459.94||||459.94|413.95|413.95|85.47
10014|ERX|0250 - PHARMACY-GENERAL|FAT EMULSION 20 % INTRAVENOUS|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|406.98||||406.98|366.28|413.95|85.47
10014|ERX|0250 - PHARMACY-GENERAL|FAT EMULSION 20 % INTRAVENOUS|FIRST HEALTH [1375]|BENVEO/UCS [137512]|406.98||||406.98|345.93|413.95|85.47
10014|ERX|0250 - PHARMACY-GENERAL|FAT EMULSION 20 % INTRAVENOUS|HEALTHNET [1495]|HEALTHNET [149500]|459.94||||459.94|413.95|413.95|85.47
10014|ERX|0250 - PHARMACY-GENERAL|FAT EMULSION 20 % INTRAVENOUS|HEALTHNET [1495]|HEALTHNET [149500]|406.98||||406.98|366.28|413.95|85.47
10014|ERX|0250 - PHARMACY-GENERAL|FAT EMULSION 20 % INTRAVENOUS|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|459.94||||459.94|413.95|413.95|85.47
10014|ERX|0250 - PHARMACY-GENERAL|FAT EMULSION 20 % INTRAVENOUS|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|406.98||||406.98|366.28|413.95|85.47
10014|ERX|0250 - PHARMACY-GENERAL|FAT EMULSION 20 % INTRAVENOUS|GROUP PENSION ADMIN [1450]|GPA [145000]|406.98||||406.98|284.89|413.95|85.47
10014|ERX|0250 - PHARMACY-GENERAL|FAT EMULSION 20 % INTRAVENOUS|CIGNA [1260]|CIGNA - GREAT WEST [126009]|406.98||||406.98|284.89|413.95|85.47
10014|ERX|0250 - PHARMACY-GENERAL|FAT EMULSION 20 % INTRAVENOUS|CIGNA [1260]|CIGNA - GREAT WEST [126009]|459.94||||459.94|321.96|413.95|85.47
10014|ERX|0250 - PHARMACY-GENERAL|FAT EMULSION 20 % INTRAVENOUS|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|459.94||||459.94|413.95|413.95|85.47
10014|ERX|0250 - PHARMACY-GENERAL|FAT EMULSION 20 % INTRAVENOUS|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|406.98||||406.98|366.28|413.95|85.47
10014|ERX|0250 - PHARMACY-GENERAL|FAT EMULSION 20 % INTRAVENOUS|FMH BENEFIT SERVICES [1390]|FMH [139000]|406.98||||406.98|366.28|413.95|85.47
10014|ERX|0250 - PHARMACY-GENERAL|FAT EMULSION 20 % INTRAVENOUS|FMH BENEFIT SERVICES [1390]|FMH [139000]|459.94||||459.94|413.95|413.95|85.47
10014|ERX|0250 - PHARMACY-GENERAL|FAT EMULSION 20 % INTRAVENOUS|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|406.98||||406.98|134.3|413.95|85.47
10014|ERX|0250 - PHARMACY-GENERAL|FAT EMULSION 20 % INTRAVENOUS|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|459.94||||459.94|151.78|413.95|85.47
10014|ERX|0250 - PHARMACY-GENERAL|FAT EMULSION 20 % INTRAVENOUS|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|406.98||||406.98|366.28|413.95|85.47
10014|ERX|0250 - PHARMACY-GENERAL|FAT EMULSION 20 % INTRAVENOUS|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|459.94||||459.94|96.59|413.95|85.47
10014|ERX|0250 - PHARMACY-GENERAL|FAT EMULSION 20 % INTRAVENOUS|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|406.98||||406.98|85.47|413.95|85.47
10014|ERX|0250 - PHARMACY-GENERAL|FAT EMULSION 20 % INTRAVENOUS|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|406.98||||406.98|203.49|413.95|85.47
10014|ERX|0250 - PHARMACY-GENERAL|FAT EMULSION 20 % INTRAVENOUS|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|459.94||||459.94|229.97|413.95|85.47
10014|ERX|0250 - PHARMACY-GENERAL|FAT EMULSION 20 % INTRAVENOUS|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|459.94||||459.94|413.95|413.95|85.47
10014|ERX|0250 - PHARMACY-GENERAL|FAT EMULSION 20 % INTRAVENOUS|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|406.98||||406.98|||
10014|ERX|0250 - PHARMACY-GENERAL|FAT EMULSION 20 % INTRAVENOUS|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|459.94||||459.94|||
10014|ERX|0250 - PHARMACY-GENERAL|FAT EMULSION 20 % INTRAVENOUS|UMR [2035]|UMR OPTIONS [203501]|406.98||||406.98|||
10014|ERX|0250 - PHARMACY-GENERAL|FAT EMULSION 20 % INTRAVENOUS|UMR [2035]|UMR OPTIONS [203501]|459.94||||459.94|||
10014|ERX|0250 - PHARMACY-GENERAL|FAT EMULSION 20 % INTRAVENOUS|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|459.94||||459.94|||
10014|ERX|0250 - PHARMACY-GENERAL|FAT EMULSION 20 % INTRAVENOUS|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|406.98||||406.98|||
10014|ERX|0250 - PHARMACY-GENERAL|FAT EMULSION 20 % INTRAVENOUS|MULTIPLAN [1680]|HMA [168003]|459.94||||459.94|||
10014|ERX|0250 - PHARMACY-GENERAL|FAT EMULSION 20 % INTRAVENOUS|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|459.94||||459.94|||
10014|ERX|0250 - PHARMACY-GENERAL|FAT EMULSION 20 % INTRAVENOUS|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|406.98||||406.98|||
10014|ERX|0250 - PHARMACY-GENERAL|FAT EMULSION 20 % INTRAVENOUS|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|459.94||||459.94|||
10014|ERX|0250 - PHARMACY-GENERAL|FAT EMULSION 20 % INTRAVENOUS|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|406.98||||406.98|||
10014|ERX|0250 - PHARMACY-GENERAL|FAT EMULSION 20 % INTRAVENOUS|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|459.94||||459.94|||
10014|ERX|0250 - PHARMACY-GENERAL|FAT EMULSION 20 % INTRAVENOUS|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|406.98||||406.98|||
10014|ERX|0250 - PHARMACY-GENERAL|FAT EMULSION 20 % INTRAVENOUS|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|459.94||||459.94|||
10014|ERX|0250 - PHARMACY-GENERAL|FAT EMULSION 20 % INTRAVENOUS|UNITED HEALTHCARE [2060]|UHC MEDICA CHOICE [206030]|406.98||||406.98|||
10014|ERX|0250 - PHARMACY-GENERAL|FAT EMULSION 20 % INTRAVENOUS|GEHA [1415]|GEHA - ASA [141503]|459.94||||459.94|||
10014|ERX|0250 - PHARMACY-GENERAL|FAT EMULSION 20 % INTRAVENOUS|GEHA [1415]|GEHA - ASA [141503]|406.98||||406.98|||
10014|ERX|0250 - PHARMACY-GENERAL|FAT EMULSION 20 % INTRAVENOUS|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|459.94||||459.94|||
10014|ERX|0250 - PHARMACY-GENERAL|FAT EMULSION 20 % INTRAVENOUS|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|406.98||||406.98|||
10014|ERX|0250 - PHARMACY-GENERAL|FAT EMULSION 20 % INTRAVENOUS|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|406.98||||406.98|||
10014|ERX|0250 - PHARMACY-GENERAL|FAT EMULSION 20 % INTRAVENOUS|AETNA [1015]|AETNA ACO WILCO [101532]|406.98||||406.98|||
10014|ERX|0250 - PHARMACY-GENERAL|FAT EMULSION 20 % INTRAVENOUS|AETNA [1015]|AETNA ACO WILCO [101532]|459.94||||459.94|||
10014|ERX|0250 - PHARMACY-GENERAL|FAT EMULSION 20 % INTRAVENOUS|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|459.94||||459.94|||
10014|ERX|0250 - PHARMACY-GENERAL|FAT EMULSION 20 % INTRAVENOUS|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|459.94||||459.94|||
10014|ERX|0250 - PHARMACY-GENERAL|FAT EMULSION 20 % INTRAVENOUS|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|459.94||||459.94|||
10014|ERX|0250 - PHARMACY-GENERAL|FAT EMULSION 20 % INTRAVENOUS|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|406.98||||406.98|||
10014|ERX|0250 - PHARMACY-GENERAL|FAT EMULSION 20 % INTRAVENOUS|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|406.98||||406.98|||
10014|ERX|0250 - PHARMACY-GENERAL|FAT EMULSION 20 % INTRAVENOUS|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|406.98||||406.98|||
10014|ERX|0250 - PHARMACY-GENERAL|FAT EMULSION 20 % INTRAVENOUS|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|459.94||||459.94|||
10014|ERX|0250 - PHARMACY-GENERAL|FAT EMULSION 20 % INTRAVENOUS|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|459.94||||459.94|||
10014|ERX|0250 - PHARMACY-GENERAL|FAT EMULSION 20 % INTRAVENOUS|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|406.98||||406.98|||
10014|ERX|0250 - PHARMACY-GENERAL|FAT EMULSION 20 % INTRAVENOUS|CHAMPVA [1240]|CHAMP VA [124000]|459.94||||459.94|||
10014|ERX|0250 - PHARMACY-GENERAL|FAT EMULSION 20 % INTRAVENOUS|CHAMPVA [1240]|CHAMP VA [124000]|406.98||||406.98|||
10014|ERX|0250 - PHARMACY-GENERAL|FAT EMULSION 20 % INTRAVENOUS|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|459.94||||459.94|||
10014|ERX|0250 - PHARMACY-GENERAL|FAT EMULSION 20 % INTRAVENOUS|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|406.98||||406.98|||
10014|ERX|0250 - PHARMACY-GENERAL|FAT EMULSION 20 % INTRAVENOUS|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|459.94||||459.94|||
10014|ERX|0250 - PHARMACY-GENERAL|FAT EMULSION 20 % INTRAVENOUS|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|406.98||||406.98|||
10014|ERX|0250 - PHARMACY-GENERAL|FAT EMULSION 20 % INTRAVENOUS|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|459.94||||459.94|||
10014|ERX|0250 - PHARMACY-GENERAL|FAT EMULSION 20 % INTRAVENOUS|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|406.98||||406.98|||
10014|ERX|0250 - PHARMACY-GENERAL|FAT EMULSION 20 % INTRAVENOUS|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|459.94||||459.94|||
10014|ERX|0250 - PHARMACY-GENERAL|FAT EMULSION 20 % INTRAVENOUS|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|406.98||||406.98|||
10014|ERX|0250 - PHARMACY-GENERAL|FAT EMULSION 20 % INTRAVENOUS|UNITED HEALTHCARE [2060]|UHC MEDICA CHOICE [206030]|459.94||||459.94|||
10014|ERX|0250 - PHARMACY-GENERAL|FAT EMULSION 20 % INTRAVENOUS|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|459.94||||459.94|||
10014|ERX|0250 - PHARMACY-GENERAL|FAT EMULSION 20 % INTRAVENOUS|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|406.98||||406.98|||
10014|ERX|0250 - PHARMACY-GENERAL|FAT EMULSION 20 % INTRAVENOUS|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|406.98||||406.98|||
10014|ERX|0250 - PHARMACY-GENERAL|FAT EMULSION 20 % INTRAVENOUS|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|406.98||||406.98|||
10014|ERX|0250 - PHARMACY-GENERAL|FAT EMULSION 20 % INTRAVENOUS|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|459.94||||459.94|||
10014|ERX|0250 - PHARMACY-GENERAL|FAT EMULSION 20 % INTRAVENOUS|MULTIPLAN [1680]|HMA [168003]|406.98||||406.98|||
10014|ERX|0250 - PHARMACY-GENERAL|FAT EMULSION 20 % INTRAVENOUS|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|459.94||||459.94|||
10014|ERX|0250 - PHARMACY-GENERAL|FAT EMULSION 20 % INTRAVENOUS|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|406.98||||406.98|||
10014|ERX|0250 - PHARMACY-GENERAL|FAT EMULSION 20 % INTRAVENOUS|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|459.94||||459.94|413.95|413.95|85.47
10014|ERX|0250 - PHARMACY-GENERAL|FAT EMULSION 20 % INTRAVENOUS|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|406.98||||406.98|366.28|413.95|85.47
10014|ERX|0250 - PHARMACY-GENERAL|FAT EMULSION 20 % INTRAVENOUS|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|459.94||||459.94|197.77|413.95|85.47
10014|ERX|0250 - PHARMACY-GENERAL|FAT EMULSION 20 % INTRAVENOUS|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|406.98||||406.98|175|413.95|85.47
10014|ERX|0250 - PHARMACY-GENERAL|FAT EMULSION 20 % INTRAVENOUS|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|459.94||||459.94|354.15|413.95|85.47
10014|ERX|0250 - PHARMACY-GENERAL|FAT EMULSION 20 % INTRAVENOUS|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|406.98||||406.98|313.37|413.95|85.47
10014|ERX|0250 - PHARMACY-GENERAL|FAT EMULSION 20 % INTRAVENOUS|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|406.98||||406.98|||
10014|ERX|0250 - PHARMACY-GENERAL|FAT EMULSION 20 % INTRAVENOUS|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|459.94||||459.94|||
10014|ERX|0250 - PHARMACY-GENERAL|FAT EMULSION 20 % INTRAVENOUS|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|459.94||||459.94|||
10014|ERX|0250 - PHARMACY-GENERAL|FAT EMULSION 20 % INTRAVENOUS|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|406.98||||406.98|||
10014|ERX|0250 - PHARMACY-GENERAL|FAT EMULSION 20 % INTRAVENOUS|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|459.94||||459.94|||
10014|ERX|0250 - PHARMACY-GENERAL|FAT EMULSION 20 % INTRAVENOUS|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|406.98||||406.98|||
10014|ERX|0250 - PHARMACY-GENERAL|FAT EMULSION 20 % INTRAVENOUS|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|459.94||||459.94|||
10014|ERX|0250 - PHARMACY-GENERAL|FAT EMULSION 20 % INTRAVENOUS|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|406.98||||406.98|||
10014|ERX|0250 - PHARMACY-GENERAL|FAT EMULSION 20 % INTRAVENOUS|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|406.98||||406.98|||
10014|ERX|0250 - PHARMACY-GENERAL|FAT EMULSION 20 % INTRAVENOUS|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|459.94||||459.94|||
100159|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL V40 COCR +0 MM TAPER OD22.2 MM HIP|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|1330.00||||1330.00|571.9|1197|279.3
100159|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL V40 COCR +0 MM TAPER OD22.2 MM HIP|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|1330.00||||1330.00|1024.1|1197|279.3
100159|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL V40 COCR +0 MM TAPER OD22.2 MM HIP|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|1330.00||||1330.00|665|1197|279.3
100159|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL V40 COCR +0 MM TAPER OD22.2 MM HIP|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|1330.00||||1330.00|1197|1197|279.3
100159|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL V40 COCR +0 MM TAPER OD22.2 MM HIP|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|1330.00||||1330.00|665|1197|279.3
100159|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL V40 COCR +0 MM TAPER OD22.2 MM HIP|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|1330.00||||1330.00|279.3|1197|279.3
100159|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL V40 COCR +0 MM TAPER OD22.2 MM HIP|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|1330.00||||1330.00|438.9|1197|279.3
100159|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL V40 COCR +0 MM TAPER OD22.2 MM HIP|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|1330.00||||1330.00|1197|1197|279.3
100159|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL V40 COCR +0 MM TAPER OD22.2 MM HIP|CIGNA [1260]|CIGNA - GREAT WEST [126009]|1330.00||||1330.00|931|1197|279.3
100159|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL V40 COCR +0 MM TAPER OD22.2 MM HIP|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|1330.00||||1330.00|1197|1197|279.3
100159|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL V40 COCR +0 MM TAPER OD22.2 MM HIP|HEALTHNET [1495]|HEALTHNET [149500]|1330.00||||1330.00|1197|1197|279.3
100159|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL V40 COCR +0 MM TAPER OD22.2 MM HIP|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|1330.00||||1330.00|1197|1197|279.3
100159|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL V40 COCR +0 MM TAPER OD22.2 MM HIP|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|1330.00||||1330.00|1197|1197|279.3
100159|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL V40 COCR +0 MM TAPER OD22.2 MM HIP|CORESOURCE [1315]|CORESOURCE [131500]|1330.00||||1330.00|1197|1197|279.3
100159|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL V40 COCR +0 MM TAPER OD22.2 MM HIP|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|1330.00||||1330.00|864.5|1197|279.3
100159|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL V40 COCR +0 MM TAPER OD22.2 MM HIP|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|1330.00||||1330.00|1197|1197|279.3
100159|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL V40 COCR +0 MM TAPER OD22.2 MM HIP|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|1330.00||||1330.00|1197|1197|279.3
100159|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL V40 COCR +0 MM TAPER OD22.2 MM HIP|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|1330.00||||1330.00|571.9|1197|279.3
100159|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL V40 COCR +0 MM TAPER OD22.2 MM HIP|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|1330.00||||1330.00|770.07|1197|279.3
100159|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL V40 COCR +0 MM TAPER OD22.2 MM HIP|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|1330.00||||1330.00|538.65|1197|279.3
100159|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL V40 COCR +0 MM TAPER OD22.2 MM HIP|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|1330.00||||1330.00|654.36|1197|279.3
100159|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL V40 COCR +0 MM TAPER OD22.2 MM HIP|AETNA [1015]|COVENTRY HEALTHCARE [101502]|1330.00||||1330.00|1197|1197|279.3
100159|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL V40 COCR +0 MM TAPER OD22.2 MM HIP|AETNA [1015]|AMERICAN CONTINENTAL [101507]|1330.00||||1330.00|931|1197|279.3
100159|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL V40 COCR +0 MM TAPER OD22.2 MM HIP|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|1330.00||||1330.00|1197|1197|279.3
100159|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL V40 COCR +0 MM TAPER OD22.2 MM HIP|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|1330.00||||1330.00|424.27|1197|279.3
100159|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL V40 COCR +0 MM TAPER OD22.2 MM HIP|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|1330.00||||1330.00|1197|1197|279.3
100159|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL V40 COCR +0 MM TAPER OD22.2 MM HIP|MULTIPLAN [1680]|IHC HS [168011]|1330.00||||1330.00|1197|1197|279.3
100159|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL V40 COCR +0 MM TAPER OD22.2 MM HIP|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|1330.00||||1330.00|1197|1197|279.3
100159|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL V40 COCR +0 MM TAPER OD22.2 MM HIP|FMH BENEFIT SERVICES [1390]|FMH [139000]|1330.00||||1330.00|1197|1197|279.3
100159|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL V40 COCR +0 MM TAPER OD22.2 MM HIP|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|1330.00||||1330.00|864.5|1197|279.3
100159|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL V40 COCR +0 MM TAPER OD22.2 MM HIP|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|1330.00||||1330.00|864.5|1197|279.3
100159|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL V40 COCR +0 MM TAPER OD22.2 MM HIP|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|1330.00||||1330.00|1197|1197|279.3
100159|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL V40 COCR +0 MM TAPER OD22.2 MM HIP|<Self-pay>|<Self-pay>|1330.00||||1330.00|399|1197|279.3
100159|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL V40 COCR +0 MM TAPER OD22.2 MM HIP|FIRST HEALTH [1375]|QUALCHOICE [137513]|1330.00||||1330.00|1197|1197|279.3
100159|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL V40 COCR +0 MM TAPER OD22.2 MM HIP|FIRST HEALTH [1375]|BENVEO/UCS [137512]|1330.00||||1330.00|1130.5|1197|279.3
100159|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL V40 COCR +0 MM TAPER OD22.2 MM HIP|GROUP PENSION ADMIN [1450]|GPA [145000]|1330.00||||1330.00|931|1197|279.3
100159|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL V40 COCR +0 MM TAPER OD22.2 MM HIP|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|1330.00||||1330.00|1197|1197|279.3
100159|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL V40 COCR +0 MM TAPER OD22.2 MM HIP|TRUSTMARK [2030]|STARMARK [203000]|1330.00||||1330.00|1197|1197|279.3
100159|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL V40 COCR +0 MM TAPER OD22.2 MM HIP|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|1330.00||||1330.00|1197|1197|279.3
100159|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL V40 COCR +0 MM TAPER OD22.2 MM HIP|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|1330.00||||1330.00|1197|1197|279.3
100159|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL V40 COCR +0 MM TAPER OD22.2 MM HIP|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|1330.00||||1330.00|1197|1197|279.3
100159|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL V40 COCR +0 MM TAPER OD22.2 MM HIP|SAMBA HEALTH [2305]|SAMBA HEALTH [230500]|1330.00||||1330.00|931|1197|279.3
100159|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL V40 COCR +0 MM TAPER OD22.2 MM HIP|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|1330.00||||1330.00|||
100159|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL V40 COCR +0 MM TAPER OD22.2 MM HIP|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|1330.00||||1330.00|||
100159|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL V40 COCR +0 MM TAPER OD22.2 MM HIP|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|1330.00||||1330.00|||
100159|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL V40 COCR +0 MM TAPER OD22.2 MM HIP|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|1330.00||||1330.00|||
100159|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL V40 COCR +0 MM TAPER OD22.2 MM HIP|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|1330.00||||1330.00|||
100159|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL V40 COCR +0 MM TAPER OD22.2 MM HIP|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|1330.00||||1330.00|||
100159|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL V40 COCR +0 MM TAPER OD22.2 MM HIP|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|1330.00||||1330.00|||
100159|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL V40 COCR +0 MM TAPER OD22.2 MM HIP|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|1330.00||||1330.00|||
100159|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL V40 COCR +0 MM TAPER OD22.2 MM HIP|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|1330.00||||1330.00|||
100159|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL V40 COCR +0 MM TAPER OD22.2 MM HIP|CHAMPVA [1240]|CHAMP VA [124000]|1330.00||||1330.00|||
100159|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL V40 COCR +0 MM TAPER OD22.2 MM HIP|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|1330.00||||1330.00|||
100159|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL V40 COCR +0 MM TAPER OD22.2 MM HIP|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|1330.00||||1330.00|||
100159|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL V40 COCR +0 MM TAPER OD22.2 MM HIP|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|1330.00||||1330.00|||
100159|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL V40 COCR +0 MM TAPER OD22.2 MM HIP|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|1330.00||||1330.00|||
100159|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL V40 COCR +0 MM TAPER OD22.2 MM HIP|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|1330.00||||1330.00|||
100159|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL V40 COCR +0 MM TAPER OD22.2 MM HIP|AETNA [1015]|AETNA ACO WILCO [101532]|1330.00||||1330.00|||
100159|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL V40 COCR +0 MM TAPER OD22.2 MM HIP|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|1330.00||||1330.00|||
100159|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL V40 COCR +0 MM TAPER OD22.2 MM HIP|MULTIPLAN [1680]|HMA [168003]|1330.00||||1330.00|||
100159|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL V40 COCR +0 MM TAPER OD22.2 MM HIP|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|1330.00||||1330.00|||
100159|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL V40 COCR +0 MM TAPER OD22.2 MM HIP|GEHA [1415]|GEHA - ASA [141503]|1330.00||||1330.00|||
100159|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL V40 COCR +0 MM TAPER OD22.2 MM HIP|UNITED HEALTHCARE [2060]|UHC MEDICA CHOICE [206030]|1330.00||||1330.00|||
100159|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL V40 COCR +0 MM TAPER OD22.2 MM HIP|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|1330.00||||1330.00|||
100159|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL V40 COCR +0 MM TAPER OD22.2 MM HIP|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|1330.00||||1330.00|||
100159|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL V40 COCR +0 MM TAPER OD22.2 MM HIP|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|1330.00||||1330.00|||
100159|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL V40 COCR +0 MM TAPER OD22.2 MM HIP|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|1330.00||||1330.00|||
100159|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL V40 COCR +0 MM TAPER OD22.2 MM HIP|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|1330.00||||1330.00|||
100159|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL V40 COCR +0 MM TAPER OD22.2 MM HIP|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|1330.00||||1330.00|||
100159|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL V40 COCR +0 MM TAPER OD22.2 MM HIP|UMR [2035]|UMR OPTIONS [203501]|1330.00||||1330.00|||
100159|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL V40 COCR +0 MM TAPER OD22.2 MM HIP|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|1330.00||||1330.00|||
100168|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 41MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|SAMBA HEALTH [2305]|SAMBA HEALTH [230500]|1240.00||||1240.00|868|1116|260.4
100168|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 41MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|1240.00||||1240.00|1116|1116|260.4
100168|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 41MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|1240.00||||1240.00|1116|1116|260.4
100168|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 41MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|TRUSTMARK [2030]|STARMARK [203000]|1240.00||||1240.00|1116|1116|260.4
100168|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 41MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|1240.00||||1240.00|1116|1116|260.4
100168|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 41MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|GROUP PENSION ADMIN [1450]|GPA [145000]|1240.00||||1240.00|868|1116|260.4
100168|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 41MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|FIRST HEALTH [1375]|QUALCHOICE [137513]|1240.00||||1240.00|1116|1116|260.4
100168|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 41MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|<Self-pay>|<Self-pay>|1240.00||||1240.00|372|1116|260.4
100168|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 41MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|1240.00||||1240.00|1116|1116|260.4
100168|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 41MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|1240.00||||1240.00|806|1116|260.4
100168|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 41MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|1240.00||||1240.00|1116|1116|260.4
100168|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 41MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|MULTIPLAN [1680]|IHC HS [168011]|1240.00||||1240.00|1116|1116|260.4
100168|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 41MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|1240.00||||1240.00|1116|1116|260.4
100168|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 41MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|AETNA [1015]|COVENTRY HEALTHCARE [101502]|1240.00||||1240.00|1116|1116|260.4
100168|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 41MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|1240.00||||1240.00|717.96|1116|260.4
100168|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 41MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|1240.00||||1240.00|502.2|1116|260.4
100168|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 41MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|1240.00||||1240.00|610.08|1116|260.4
100168|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 41MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|1240.00||||1240.00|533.2|1116|260.4
100168|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 41MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|AETNA [1015]|AMERICAN CONTINENTAL [101507]|1240.00||||1240.00|868|1116|260.4
100168|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 41MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|1240.00||||1240.00|1116|1116|260.4
100168|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 41MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|1240.00||||1240.00|1116|1116|260.4
100168|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 41MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|1240.00||||1240.00|806|1116|260.4
100168|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 41MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|CORESOURCE [1315]|CORESOURCE [131500]|1240.00||||1240.00|1116|1116|260.4
100168|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 41MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|1240.00||||1240.00|806|1116|260.4
100168|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 41MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|1240.00||||1240.00|1116|1116|260.4
100168|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 41MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|1240.00||||1240.00|1116|1116|260.4
100168|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 41MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|1240.00||||1240.00|395.56|1116|260.4
100168|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 41MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|FIRST HEALTH [1375]|BENVEO/UCS [137512]|1240.00||||1240.00|1054|1116|260.4
100168|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 41MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|HEALTHNET [1495]|HEALTHNET [149500]|1240.00||||1240.00|1116|1116|260.4
100168|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 41MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|1240.00||||1240.00|1116|1116|260.4
100168|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 41MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|1240.00||||1240.00|1116|1116|260.4
100168|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 41MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|CIGNA [1260]|CIGNA - GREAT WEST [126009]|1240.00||||1240.00|868|1116|260.4
100168|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 41MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|1240.00||||1240.00|1116|1116|260.4
100168|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 41MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|1240.00||||1240.00|1116|1116|260.4
100168|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 41MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|FMH BENEFIT SERVICES [1390]|FMH [139000]|1240.00||||1240.00|1116|1116|260.4
100168|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 41MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|1240.00||||1240.00|409.2|1116|260.4
100168|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 41MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|1240.00||||1240.00|260.4|1116|260.4
100168|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 41MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|1240.00||||1240.00|620|1116|260.4
100168|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 41MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|1240.00||||1240.00|1116|1116|260.4
100168|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 41MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|1240.00||||1240.00|620|1116|260.4
100168|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 41MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|1240.00||||1240.00|954.8|1116|260.4
100168|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 41MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|1240.00||||1240.00|533.2|1116|260.4
100168|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 41MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|1240.00||||1240.00|||
100168|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 41MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|UMR [2035]|UMR OPTIONS [203501]|1240.00||||1240.00|||
100168|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 41MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|1240.00||||1240.00|||
100168|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 41MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|1240.00||||1240.00|||
100168|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 41MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|1240.00||||1240.00|||
100168|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 41MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|UNITED HEALTHCARE [2060]|UHC MEDICA CHOICE [206030]|1240.00||||1240.00|||
100168|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 41MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|GEHA [1415]|GEHA - ASA [141503]|1240.00||||1240.00|||
100168|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 41MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|1240.00||||1240.00|||
100168|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 41MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|1240.00||||1240.00|||
100168|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 41MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|1240.00||||1240.00|||
100168|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 41MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|AETNA [1015]|AETNA ACO WILCO [101532]|1240.00||||1240.00|||
100168|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 41MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|1240.00||||1240.00|||
100168|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 41MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|1240.00||||1240.00|||
100168|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 41MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|MULTIPLAN [1680]|HMA [168003]|1240.00||||1240.00|||
100168|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 41MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|1240.00||||1240.00|||
100168|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 41MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|1240.00||||1240.00|||
100168|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 41MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|CHAMPVA [1240]|CHAMP VA [124000]|1240.00||||1240.00|||
100168|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 41MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|1240.00||||1240.00|||
100168|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 41MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|1240.00||||1240.00|||
100168|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 41MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|1240.00||||1240.00|||
100168|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 41MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|1240.00||||1240.00|||
100168|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 41MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|1240.00||||1240.00|||
100168|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 41MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|1240.00||||1240.00|||
100168|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 41MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|1240.00||||1240.00|||
100168|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 41MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|1240.00||||1240.00|||
100168|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 41MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|1240.00||||1240.00|||
100168|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 41MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|1240.00||||1240.00|||
100168|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 41MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|1240.00||||1240.00|||
100168|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 41MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|1240.00||||1240.00|||
10017|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L12 MM OD2.7 MM ODSEC5 MM CORTEX SELF TAP SPHERICAL HEAD SMALL HEXAGONAL SOCKET NONSTERILE MODULAR MINI FRAGMENT SET|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|183.00||||183.00|78.69|164.7|38.43
10017|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L12 MM OD2.7 MM ODSEC5 MM CORTEX SELF TAP SPHERICAL HEAD SMALL HEXAGONAL SOCKET NONSTERILE MODULAR MINI FRAGMENT SET|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|183.00||||183.00|91.5|164.7|38.43
10017|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L12 MM OD2.7 MM ODSEC5 MM CORTEX SELF TAP SPHERICAL HEAD SMALL HEXAGONAL SOCKET NONSTERILE MODULAR MINI FRAGMENT SET|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|183.00||||183.00|164.7|164.7|38.43
10017|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L12 MM OD2.7 MM ODSEC5 MM CORTEX SELF TAP SPHERICAL HEAD SMALL HEXAGONAL SOCKET NONSTERILE MODULAR MINI FRAGMENT SET|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|183.00||||183.00|91.5|164.7|38.43
10017|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L12 MM OD2.7 MM ODSEC5 MM CORTEX SELF TAP SPHERICAL HEAD SMALL HEXAGONAL SOCKET NONSTERILE MODULAR MINI FRAGMENT SET|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|183.00||||183.00|38.43|164.7|38.43
10017|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L12 MM OD2.7 MM ODSEC5 MM CORTEX SELF TAP SPHERICAL HEAD SMALL HEXAGONAL SOCKET NONSTERILE MODULAR MINI FRAGMENT SET|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|183.00||||183.00|60.39|164.7|38.43
10017|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L12 MM OD2.7 MM ODSEC5 MM CORTEX SELF TAP SPHERICAL HEAD SMALL HEXAGONAL SOCKET NONSTERILE MODULAR MINI FRAGMENT SET|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|183.00||||183.00|164.7|164.7|38.43
10017|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L12 MM OD2.7 MM ODSEC5 MM CORTEX SELF TAP SPHERICAL HEAD SMALL HEXAGONAL SOCKET NONSTERILE MODULAR MINI FRAGMENT SET|FMH BENEFIT SERVICES [1390]|FMH [139000]|183.00||||183.00|164.7|164.7|38.43
10017|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L12 MM OD2.7 MM ODSEC5 MM CORTEX SELF TAP SPHERICAL HEAD SMALL HEXAGONAL SOCKET NONSTERILE MODULAR MINI FRAGMENT SET|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|183.00||||183.00|164.7|164.7|38.43
10017|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L12 MM OD2.7 MM ODSEC5 MM CORTEX SELF TAP SPHERICAL HEAD SMALL HEXAGONAL SOCKET NONSTERILE MODULAR MINI FRAGMENT SET|HEALTHNET [1495]|HEALTHNET [149500]|183.00||||183.00|164.7|164.7|38.43
10017|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L12 MM OD2.7 MM ODSEC5 MM CORTEX SELF TAP SPHERICAL HEAD SMALL HEXAGONAL SOCKET NONSTERILE MODULAR MINI FRAGMENT SET|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|183.00||||183.00|164.7|164.7|38.43
10017|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L12 MM OD2.7 MM ODSEC5 MM CORTEX SELF TAP SPHERICAL HEAD SMALL HEXAGONAL SOCKET NONSTERILE MODULAR MINI FRAGMENT SET|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|183.00||||183.00|58.38|164.7|38.43
10017|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L12 MM OD2.7 MM ODSEC5 MM CORTEX SELF TAP SPHERICAL HEAD SMALL HEXAGONAL SOCKET NONSTERILE MODULAR MINI FRAGMENT SET|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|183.00||||183.00|164.7|164.7|38.43
10017|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L12 MM OD2.7 MM ODSEC5 MM CORTEX SELF TAP SPHERICAL HEAD SMALL HEXAGONAL SOCKET NONSTERILE MODULAR MINI FRAGMENT SET|CORESOURCE [1315]|CORESOURCE [131500]|183.00||||183.00|164.7|164.7|38.43
10017|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L12 MM OD2.7 MM ODSEC5 MM CORTEX SELF TAP SPHERICAL HEAD SMALL HEXAGONAL SOCKET NONSTERILE MODULAR MINI FRAGMENT SET|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|183.00||||183.00|164.7|164.7|38.43
10017|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L12 MM OD2.7 MM ODSEC5 MM CORTEX SELF TAP SPHERICAL HEAD SMALL HEXAGONAL SOCKET NONSTERILE MODULAR MINI FRAGMENT SET|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|183.00||||183.00|164.7|164.7|38.43
10017|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L12 MM OD2.7 MM ODSEC5 MM CORTEX SELF TAP SPHERICAL HEAD SMALL HEXAGONAL SOCKET NONSTERILE MODULAR MINI FRAGMENT SET|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|183.00||||183.00|118.95|164.7|38.43
10017|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L12 MM OD2.7 MM ODSEC5 MM CORTEX SELF TAP SPHERICAL HEAD SMALL HEXAGONAL SOCKET NONSTERILE MODULAR MINI FRAGMENT SET|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|183.00||||183.00|90.04|164.7|38.43
10017|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L12 MM OD2.7 MM ODSEC5 MM CORTEX SELF TAP SPHERICAL HEAD SMALL HEXAGONAL SOCKET NONSTERILE MODULAR MINI FRAGMENT SET|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|183.00||||183.00|164.7|164.7|38.43
10017|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L12 MM OD2.7 MM ODSEC5 MM CORTEX SELF TAP SPHERICAL HEAD SMALL HEXAGONAL SOCKET NONSTERILE MODULAR MINI FRAGMENT SET|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|183.00||||183.00|105.96|164.7|38.43
10017|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L12 MM OD2.7 MM ODSEC5 MM CORTEX SELF TAP SPHERICAL HEAD SMALL HEXAGONAL SOCKET NONSTERILE MODULAR MINI FRAGMENT SET|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|183.00||||183.00|78.69|164.7|38.43
10017|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L12 MM OD2.7 MM ODSEC5 MM CORTEX SELF TAP SPHERICAL HEAD SMALL HEXAGONAL SOCKET NONSTERILE MODULAR MINI FRAGMENT SET|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|183.00||||183.00|74.12|164.7|38.43
10017|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L12 MM OD2.7 MM ODSEC5 MM CORTEX SELF TAP SPHERICAL HEAD SMALL HEXAGONAL SOCKET NONSTERILE MODULAR MINI FRAGMENT SET|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|183.00||||183.00|164.7|164.7|38.43
10017|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L12 MM OD2.7 MM ODSEC5 MM CORTEX SELF TAP SPHERICAL HEAD SMALL HEXAGONAL SOCKET NONSTERILE MODULAR MINI FRAGMENT SET|AETNA [1015]|COVENTRY HEALTHCARE [101502]|183.00||||183.00|164.7|164.7|38.43
10017|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L12 MM OD2.7 MM ODSEC5 MM CORTEX SELF TAP SPHERICAL HEAD SMALL HEXAGONAL SOCKET NONSTERILE MODULAR MINI FRAGMENT SET|AETNA [1015]|AMERICAN CONTINENTAL [101507]|183.00||||183.00|128.1|164.7|38.43
10017|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L12 MM OD2.7 MM ODSEC5 MM CORTEX SELF TAP SPHERICAL HEAD SMALL HEXAGONAL SOCKET NONSTERILE MODULAR MINI FRAGMENT SET|CIGNA [1260]|CIGNA - GREAT WEST [126009]|183.00||||183.00|128.1|164.7|38.43
10017|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L12 MM OD2.7 MM ODSEC5 MM CORTEX SELF TAP SPHERICAL HEAD SMALL HEXAGONAL SOCKET NONSTERILE MODULAR MINI FRAGMENT SET|MULTIPLAN [1680]|IHC HS [168011]|183.00||||183.00|164.7|164.7|38.43
10017|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L12 MM OD2.7 MM ODSEC5 MM CORTEX SELF TAP SPHERICAL HEAD SMALL HEXAGONAL SOCKET NONSTERILE MODULAR MINI FRAGMENT SET|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|183.00||||183.00|164.7|164.7|38.43
10017|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L12 MM OD2.7 MM ODSEC5 MM CORTEX SELF TAP SPHERICAL HEAD SMALL HEXAGONAL SOCKET NONSTERILE MODULAR MINI FRAGMENT SET|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|183.00||||183.00|118.95|164.7|38.43
10017|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L12 MM OD2.7 MM ODSEC5 MM CORTEX SELF TAP SPHERICAL HEAD SMALL HEXAGONAL SOCKET NONSTERILE MODULAR MINI FRAGMENT SET|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|183.00||||183.00|118.95|164.7|38.43
10017|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L12 MM OD2.7 MM ODSEC5 MM CORTEX SELF TAP SPHERICAL HEAD SMALL HEXAGONAL SOCKET NONSTERILE MODULAR MINI FRAGMENT SET|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|183.00||||183.00|164.7|164.7|38.43
10017|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L12 MM OD2.7 MM ODSEC5 MM CORTEX SELF TAP SPHERICAL HEAD SMALL HEXAGONAL SOCKET NONSTERILE MODULAR MINI FRAGMENT SET|<Self-pay>|<Self-pay>|183.00||||183.00|54.9|164.7|38.43
10017|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L12 MM OD2.7 MM ODSEC5 MM CORTEX SELF TAP SPHERICAL HEAD SMALL HEXAGONAL SOCKET NONSTERILE MODULAR MINI FRAGMENT SET|FIRST HEALTH [1375]|BENVEO/UCS [137512]|183.00||||183.00|155.55|164.7|38.43
10017|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L12 MM OD2.7 MM ODSEC5 MM CORTEX SELF TAP SPHERICAL HEAD SMALL HEXAGONAL SOCKET NONSTERILE MODULAR MINI FRAGMENT SET|FIRST HEALTH [1375]|QUALCHOICE [137513]|183.00||||183.00|164.7|164.7|38.43
10017|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L12 MM OD2.7 MM ODSEC5 MM CORTEX SELF TAP SPHERICAL HEAD SMALL HEXAGONAL SOCKET NONSTERILE MODULAR MINI FRAGMENT SET|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|183.00||||183.00|140.91|164.7|38.43
10017|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L12 MM OD2.7 MM ODSEC5 MM CORTEX SELF TAP SPHERICAL HEAD SMALL HEXAGONAL SOCKET NONSTERILE MODULAR MINI FRAGMENT SET|GROUP PENSION ADMIN [1450]|GPA [145000]|183.00||||183.00|128.1|164.7|38.43
10017|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L12 MM OD2.7 MM ODSEC5 MM CORTEX SELF TAP SPHERICAL HEAD SMALL HEXAGONAL SOCKET NONSTERILE MODULAR MINI FRAGMENT SET|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|183.00||||183.00|164.7|164.7|38.43
10017|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L12 MM OD2.7 MM ODSEC5 MM CORTEX SELF TAP SPHERICAL HEAD SMALL HEXAGONAL SOCKET NONSTERILE MODULAR MINI FRAGMENT SET|TRUSTMARK [2030]|STARMARK [203000]|183.00||||183.00|164.7|164.7|38.43
10017|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L12 MM OD2.7 MM ODSEC5 MM CORTEX SELF TAP SPHERICAL HEAD SMALL HEXAGONAL SOCKET NONSTERILE MODULAR MINI FRAGMENT SET|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|183.00||||183.00|164.7|164.7|38.43
10017|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L12 MM OD2.7 MM ODSEC5 MM CORTEX SELF TAP SPHERICAL HEAD SMALL HEXAGONAL SOCKET NONSTERILE MODULAR MINI FRAGMENT SET|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|183.00||||183.00|164.7|164.7|38.43
10017|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L12 MM OD2.7 MM ODSEC5 MM CORTEX SELF TAP SPHERICAL HEAD SMALL HEXAGONAL SOCKET NONSTERILE MODULAR MINI FRAGMENT SET|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|183.00||||183.00|164.7|164.7|38.43
10017|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L12 MM OD2.7 MM ODSEC5 MM CORTEX SELF TAP SPHERICAL HEAD SMALL HEXAGONAL SOCKET NONSTERILE MODULAR MINI FRAGMENT SET|SAMBA HEALTH [2305]|SAMBA HEALTH [230500]|183.00||||183.00|128.1|164.7|38.43
10017|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L12 MM OD2.7 MM ODSEC5 MM CORTEX SELF TAP SPHERICAL HEAD SMALL HEXAGONAL SOCKET NONSTERILE MODULAR MINI FRAGMENT SET|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|183.00||||183.00|||
10017|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L12 MM OD2.7 MM ODSEC5 MM CORTEX SELF TAP SPHERICAL HEAD SMALL HEXAGONAL SOCKET NONSTERILE MODULAR MINI FRAGMENT SET|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|183.00||||183.00|||
10017|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L12 MM OD2.7 MM ODSEC5 MM CORTEX SELF TAP SPHERICAL HEAD SMALL HEXAGONAL SOCKET NONSTERILE MODULAR MINI FRAGMENT SET|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|183.00||||183.00|||
10017|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L12 MM OD2.7 MM ODSEC5 MM CORTEX SELF TAP SPHERICAL HEAD SMALL HEXAGONAL SOCKET NONSTERILE MODULAR MINI FRAGMENT SET|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|183.00||||183.00|||
10017|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L12 MM OD2.7 MM ODSEC5 MM CORTEX SELF TAP SPHERICAL HEAD SMALL HEXAGONAL SOCKET NONSTERILE MODULAR MINI FRAGMENT SET|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|183.00||||183.00|||
10017|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L12 MM OD2.7 MM ODSEC5 MM CORTEX SELF TAP SPHERICAL HEAD SMALL HEXAGONAL SOCKET NONSTERILE MODULAR MINI FRAGMENT SET|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|183.00||||183.00|||
10017|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L12 MM OD2.7 MM ODSEC5 MM CORTEX SELF TAP SPHERICAL HEAD SMALL HEXAGONAL SOCKET NONSTERILE MODULAR MINI FRAGMENT SET|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|183.00||||183.00|||
10017|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L12 MM OD2.7 MM ODSEC5 MM CORTEX SELF TAP SPHERICAL HEAD SMALL HEXAGONAL SOCKET NONSTERILE MODULAR MINI FRAGMENT SET|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|183.00||||183.00|||
10017|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L12 MM OD2.7 MM ODSEC5 MM CORTEX SELF TAP SPHERICAL HEAD SMALL HEXAGONAL SOCKET NONSTERILE MODULAR MINI FRAGMENT SET|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|183.00||||183.00|||
10017|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L12 MM OD2.7 MM ODSEC5 MM CORTEX SELF TAP SPHERICAL HEAD SMALL HEXAGONAL SOCKET NONSTERILE MODULAR MINI FRAGMENT SET|CHAMPVA [1240]|CHAMP VA [124000]|183.00||||183.00|||
10017|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L12 MM OD2.7 MM ODSEC5 MM CORTEX SELF TAP SPHERICAL HEAD SMALL HEXAGONAL SOCKET NONSTERILE MODULAR MINI FRAGMENT SET|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|183.00||||183.00|||
10017|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L12 MM OD2.7 MM ODSEC5 MM CORTEX SELF TAP SPHERICAL HEAD SMALL HEXAGONAL SOCKET NONSTERILE MODULAR MINI FRAGMENT SET|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|183.00||||183.00|||
10017|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L12 MM OD2.7 MM ODSEC5 MM CORTEX SELF TAP SPHERICAL HEAD SMALL HEXAGONAL SOCKET NONSTERILE MODULAR MINI FRAGMENT SET|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|183.00||||183.00|||
10017|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L12 MM OD2.7 MM ODSEC5 MM CORTEX SELF TAP SPHERICAL HEAD SMALL HEXAGONAL SOCKET NONSTERILE MODULAR MINI FRAGMENT SET|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|183.00||||183.00|||
10017|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L12 MM OD2.7 MM ODSEC5 MM CORTEX SELF TAP SPHERICAL HEAD SMALL HEXAGONAL SOCKET NONSTERILE MODULAR MINI FRAGMENT SET|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|183.00||||183.00|||
10017|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L12 MM OD2.7 MM ODSEC5 MM CORTEX SELF TAP SPHERICAL HEAD SMALL HEXAGONAL SOCKET NONSTERILE MODULAR MINI FRAGMENT SET|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|183.00||||183.00|||
10017|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L12 MM OD2.7 MM ODSEC5 MM CORTEX SELF TAP SPHERICAL HEAD SMALL HEXAGONAL SOCKET NONSTERILE MODULAR MINI FRAGMENT SET|AETNA [1015]|AETNA ACO WILCO [101532]|183.00||||183.00|||
10017|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L12 MM OD2.7 MM ODSEC5 MM CORTEX SELF TAP SPHERICAL HEAD SMALL HEXAGONAL SOCKET NONSTERILE MODULAR MINI FRAGMENT SET|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|183.00||||183.00|||
10017|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L12 MM OD2.7 MM ODSEC5 MM CORTEX SELF TAP SPHERICAL HEAD SMALL HEXAGONAL SOCKET NONSTERILE MODULAR MINI FRAGMENT SET|MULTIPLAN [1680]|HMA [168003]|183.00||||183.00|||
10017|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L12 MM OD2.7 MM ODSEC5 MM CORTEX SELF TAP SPHERICAL HEAD SMALL HEXAGONAL SOCKET NONSTERILE MODULAR MINI FRAGMENT SET|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|183.00||||183.00|||
10017|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L12 MM OD2.7 MM ODSEC5 MM CORTEX SELF TAP SPHERICAL HEAD SMALL HEXAGONAL SOCKET NONSTERILE MODULAR MINI FRAGMENT SET|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|183.00||||183.00|||
10017|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L12 MM OD2.7 MM ODSEC5 MM CORTEX SELF TAP SPHERICAL HEAD SMALL HEXAGONAL SOCKET NONSTERILE MODULAR MINI FRAGMENT SET|GEHA [1415]|GEHA - ASA [141503]|183.00||||183.00|||
10017|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L12 MM OD2.7 MM ODSEC5 MM CORTEX SELF TAP SPHERICAL HEAD SMALL HEXAGONAL SOCKET NONSTERILE MODULAR MINI FRAGMENT SET|UNITED HEALTHCARE [2060]|UHC MEDICA CHOICE [206030]|183.00||||183.00|||
10017|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L12 MM OD2.7 MM ODSEC5 MM CORTEX SELF TAP SPHERICAL HEAD SMALL HEXAGONAL SOCKET NONSTERILE MODULAR MINI FRAGMENT SET|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|183.00||||183.00|||
10017|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L12 MM OD2.7 MM ODSEC5 MM CORTEX SELF TAP SPHERICAL HEAD SMALL HEXAGONAL SOCKET NONSTERILE MODULAR MINI FRAGMENT SET|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|183.00||||183.00|||
10017|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L12 MM OD2.7 MM ODSEC5 MM CORTEX SELF TAP SPHERICAL HEAD SMALL HEXAGONAL SOCKET NONSTERILE MODULAR MINI FRAGMENT SET|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|183.00||||183.00|||
10017|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L12 MM OD2.7 MM ODSEC5 MM CORTEX SELF TAP SPHERICAL HEAD SMALL HEXAGONAL SOCKET NONSTERILE MODULAR MINI FRAGMENT SET|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|183.00||||183.00|||
10017|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L12 MM OD2.7 MM ODSEC5 MM CORTEX SELF TAP SPHERICAL HEAD SMALL HEXAGONAL SOCKET NONSTERILE MODULAR MINI FRAGMENT SET|UMR [2035]|UMR OPTIONS [203501]|183.00||||183.00|||
10017|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L12 MM OD2.7 MM ODSEC5 MM CORTEX SELF TAP SPHERICAL HEAD SMALL HEXAGONAL SOCKET NONSTERILE MODULAR MINI FRAGMENT SET|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|183.00||||183.00|||
100170|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 42MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|SAMBA HEALTH [2305]|SAMBA HEALTH [230500]|1240.00||||1240.00|868|1116|260.4
100170|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 42MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|1240.00||||1240.00|1116|1116|260.4
100170|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 42MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|TRUSTMARK [2030]|STARMARK [203000]|1240.00||||1240.00|1116|1116|260.4
100170|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 42MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|1240.00||||1240.00|1116|1116|260.4
100170|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 42MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|FIRST HEALTH [1375]|BENVEO/UCS [137512]|1240.00||||1240.00|1054|1116|260.4
100170|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 42MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|FIRST HEALTH [1375]|QUALCHOICE [137513]|1240.00||||1240.00|1116|1116|260.4
100170|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 42MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|<Self-pay>|<Self-pay>|1240.00||||1240.00|372|1116|260.4
100170|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 42MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|1240.00||||1240.00|806|1116|260.4
100170|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 42MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|1240.00||||1240.00|806|1116|260.4
100170|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 42MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|MULTIPLAN [1680]|IHC HS [168011]|1240.00||||1240.00|1116|1116|260.4
100170|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 42MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|AETNA [1015]|AMERICAN CONTINENTAL [101507]|1240.00||||1240.00|868|1116|260.4
100170|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 42MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|AETNA [1015]|COVENTRY HEALTHCARE [101502]|1240.00||||1240.00|1116|1116|260.4
100170|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 42MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|1240.00||||1240.00|610.08|1116|260.4
100170|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 42MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|1240.00||||1240.00|502.2|1116|260.4
100170|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 42MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|1240.00||||1240.00|533.2|1116|260.4
100170|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 42MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|1240.00||||1240.00|717.96|1116|260.4
100170|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 42MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|1240.00||||1240.00|1116|1116|260.4
100170|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 42MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|1240.00||||1240.00|1116|1116|260.4
100170|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 42MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|1240.00||||1240.00|1116|1116|260.4
100170|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 42MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|1240.00||||1240.00|806|1116|260.4
100170|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 42MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|1240.00||||1240.00|1116|1116|260.4
100170|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 42MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|CORESOURCE [1315]|CORESOURCE [131500]|1240.00||||1240.00|1116|1116|260.4
100170|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 42MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|1240.00||||1240.00|1116|1116|260.4
100170|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 42MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|1240.00||||1240.00|1116|1116|260.4
100170|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 42MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|1240.00||||1240.00|1116|1116|260.4
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]|1240.00||||1240.00|395.56|1116|260.4
100170|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 42MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|HEALTHNET [1495]|HEALTHNET [149500]|1240.00||||1240.00|1116|1116|260.4
100170|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 42MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|GROUP PENSION ADMIN [1450]|GPA [145000]|1240.00||||1240.00|868|1116|260.4
100170|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 42MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|1240.00||||1240.00|1116|1116|260.4
100170|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 42MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|1240.00||||1240.00|1116|1116|260.4
100170|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 42MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|1240.00||||1240.00|1116|1116|260.4
100170|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 42MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|CIGNA [1260]|CIGNA - GREAT WEST [126009]|1240.00||||1240.00|868|1116|260.4
100170|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 42MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|1240.00||||1240.00|1116|1116|260.4
100170|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 42MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|FMH BENEFIT SERVICES [1390]|FMH [139000]|1240.00||||1240.00|1116|1116|260.4
100170|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 42MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|1240.00||||1240.00|1116|1116|260.4
100170|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 42MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|1240.00||||1240.00|409.2|1116|260.4
100170|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 42MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|1240.00||||1240.00|260.4|1116|260.4
100170|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 42MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|1240.00||||1240.00|620|1116|260.4
100170|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 42MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|1240.00||||1240.00|1116|1116|260.4
100170|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 42MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|1240.00||||1240.00|620|1116|260.4
100170|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 42MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|1240.00||||1240.00|954.8|1116|260.4
100170|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 42MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|1240.00||||1240.00|533.2|1116|260.4
100170|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 42MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|1240.00||||1240.00|||
100170|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 42MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|UMR [2035]|UMR OPTIONS [203501]|1240.00||||1240.00|||
100170|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 42MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|1240.00||||1240.00|||
100170|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 42MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|1240.00||||1240.00|||
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]|1240.00||||1240.00|||
100170|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 42MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|1240.00||||1240.00|||
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]|1240.00||||1240.00|||
100170|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 42MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|GEHA [1415]|GEHA - ASA [141503]|1240.00||||1240.00|||
100170|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 42MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|1240.00||||1240.00|||
100170|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 42MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|1240.00||||1240.00|||
100170|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 42MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|MULTIPLAN [1680]|HMA [168003]|1240.00||||1240.00|||
100170|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 42MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|AETNA [1015]|AETNA ACO WILCO [101532]|1240.00||||1240.00|||
100170|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 42MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|1240.00||||1240.00|||
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]|1240.00||||1240.00|||
100170|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 42MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|1240.00||||1240.00|||
100170|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 42MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|1240.00||||1240.00|||
100170|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 42MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|1240.00||||1240.00|||
100170|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 42MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|CHAMPVA [1240]|CHAMP VA [124000]|1240.00||||1240.00|||
100170|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 42MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|1240.00||||1240.00|||
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]|1240.00||||1240.00|||
100170|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 42MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|1240.00||||1240.00|||
100170|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 42MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|1240.00||||1240.00|||
100170|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 42MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|1240.00||||1240.00|||
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]|1240.00||||1240.00|||
100170|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 42MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|1240.00||||1240.00|||
100170|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 42MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|1240.00||||1240.00|||
100170|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 42MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|1240.00||||1240.00|||
100170|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 42MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|1240.00||||1240.00|||
100170|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 42MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|1240.00||||1240.00|||
100178|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 45MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|1240.00||||1240.00|533.2|1116|260.4
100178|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 45MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|1240.00||||1240.00|954.8|1116|260.4
100178|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 45MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|1240.00||||1240.00|620|1116|260.4
100178|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 45MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|1240.00||||1240.00|1116|1116|260.4
100178|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 45MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|1240.00||||1240.00|260.4|1116|260.4
100178|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 45MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|1240.00||||1240.00|409.2|1116|260.4
100178|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 45MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|1240.00||||1240.00|1116|1116|260.4
100178|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 45MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|CIGNA [1260]|CIGNA - GREAT WEST [126009]|1240.00||||1240.00|868|1116|260.4
100178|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 45MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|1240.00||||1240.00|1116|1116|260.4
100178|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 45MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|1240.00||||1240.00|1116|1116|260.4
100178|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 45MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|HEALTHNET [1495]|HEALTHNET [149500]|1240.00||||1240.00|1116|1116|260.4
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]|1240.00||||1240.00|395.56|1116|260.4
100178|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 45MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|1240.00||||1240.00|1116|1116|260.4
100178|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 45MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|1240.00||||1240.00|1116|1116|260.4
100178|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 45MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|CORESOURCE [1315]|CORESOURCE [131500]|1240.00||||1240.00|1116|1116|260.4
100178|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 45MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|1240.00||||1240.00|806|1116|260.4
100178|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 45MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|1240.00||||1240.00|1116|1116|260.4
100178|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 45MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|1240.00||||1240.00|1116|1116|260.4
100178|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 45MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|1240.00||||1240.00|502.2|1116|260.4
100178|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 45MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|1240.00||||1240.00|717.96|1116|260.4
100178|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 45MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|1240.00||||1240.00|533.2|1116|260.4
100178|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 45MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|1240.00||||1240.00|610.08|1116|260.4
100178|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 45MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|AETNA [1015]|AMERICAN CONTINENTAL [101507]|1240.00||||1240.00|868|1116|260.4
100178|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 45MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|AETNA [1015]|COVENTRY HEALTHCARE [101502]|1240.00||||1240.00|1116|1116|260.4
100178|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 45MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|1240.00||||1240.00|1116|1116|260.4
100178|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 45MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|MULTIPLAN [1680]|IHC HS [168011]|1240.00||||1240.00|1116|1116|260.4
100178|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 45MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|1240.00||||1240.00|1116|1116|260.4
100178|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 45MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|FMH BENEFIT SERVICES [1390]|FMH [139000]|1240.00||||1240.00|1116|1116|260.4
100178|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 45MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|1240.00||||1240.00|806|1116|260.4
100178|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 45MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|1240.00||||1240.00|806|1116|260.4
100178|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 45MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|1240.00||||1240.00|1116|1116|260.4
100178|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 45MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|1240.00||||1240.00|620|1116|260.4
100178|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 45MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|<Self-pay>|<Self-pay>|1240.00||||1240.00|372|1116|260.4
100178|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 45MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|FIRST HEALTH [1375]|BENVEO/UCS [137512]|1240.00||||1240.00|1054|1116|260.4
100178|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 45MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|FIRST HEALTH [1375]|QUALCHOICE [137513]|1240.00||||1240.00|1116|1116|260.4
100178|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 45MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|GROUP PENSION ADMIN [1450]|GPA [145000]|1240.00||||1240.00|868|1116|260.4
100178|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 45MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|1240.00||||1240.00|1116|1116|260.4
100178|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 45MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|1240.00||||1240.00|1116|1116|260.4
100178|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 45MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|TRUSTMARK [2030]|STARMARK [203000]|1240.00||||1240.00|1116|1116|260.4
100178|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 45MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|1240.00||||1240.00|1116|1116|260.4
100178|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 45MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|1240.00||||1240.00|1116|1116|260.4
100178|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 45MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|SAMBA HEALTH [2305]|SAMBA HEALTH [230500]|1240.00||||1240.00|868|1116|260.4
100178|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 45MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|1240.00||||1240.00|||
100178|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 45MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|1240.00||||1240.00|||
100178|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 45MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|1240.00||||1240.00|||
100178|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 45MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|1240.00||||1240.00|||
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]|1240.00||||1240.00|||
100178|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 45MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|1240.00||||1240.00|||
100178|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 45MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|1240.00||||1240.00|||
100178|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 45MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|1240.00||||1240.00|||
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]|1240.00||||1240.00|||
100178|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 45MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|CHAMPVA [1240]|CHAMP VA [124000]|1240.00||||1240.00|||
100178|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 45MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|1240.00||||1240.00|||
100178|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 45MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|1240.00||||1240.00|||
100178|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 45MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|1240.00||||1240.00|||
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]|1240.00||||1240.00|||
100178|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 45MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|1240.00||||1240.00|||
100178|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 45MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|1240.00||||1240.00|||
100178|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 45MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|AETNA [1015]|AETNA ACO WILCO [101532]|1240.00||||1240.00|||
100178|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 45MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|MULTIPLAN [1680]|HMA [168003]|1240.00||||1240.00|||
100178|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 45MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|1240.00||||1240.00|||
100178|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 45MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|1240.00||||1240.00|||
100178|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 45MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|GEHA [1415]|GEHA - ASA [141503]|1240.00||||1240.00|||
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]|1240.00||||1240.00|||
100178|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 45MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|1240.00||||1240.00|||
100178|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 45MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|1240.00||||1240.00|||
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]|1240.00||||1240.00|||
100178|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 45MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|1240.00||||1240.00|||
100178|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 45MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|1240.00||||1240.00|||
100178|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 45MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|UMR [2035]|UMR OPTIONS [203501]|1240.00||||1240.00|||
100178|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 45MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|1240.00||||1240.00|||
100181|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 46MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|1240.00||||1240.00|1116|1116|260.4
100181|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 46MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|TRUSTMARK [2030]|STARMARK [203000]|1240.00||||1240.00|1116|1116|260.4
100181|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 46MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|1240.00||||1240.00|1116|1116|260.4
100181|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 46MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|1240.00||||1240.00|1116|1116|260.4
100181|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 46MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|GROUP PENSION ADMIN [1450]|GPA [145000]|1240.00||||1240.00|868|1116|260.4
100181|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 46MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|FIRST HEALTH [1375]|BENVEO/UCS [137512]|1240.00||||1240.00|1054|1116|260.4
100181|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 46MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|FIRST HEALTH [1375]|QUALCHOICE [137513]|1240.00||||1240.00|1116|1116|260.4
100181|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 46MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|1240.00||||1240.00|1116|1116|260.4
100181|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 46MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|1240.00||||1240.00|806|1116|260.4
100181|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 46MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|1240.00||||1240.00|1116|1116|260.4
100181|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 46MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|MULTIPLAN [1680]|IHC HS [168011]|1240.00||||1240.00|1116|1116|260.4
100181|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 46MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|1240.00||||1240.00|1116|1116|260.4
100181|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 46MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|AETNA [1015]|COVENTRY HEALTHCARE [101502]|1240.00||||1240.00|1116|1116|260.4
100181|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 46MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|AETNA [1015]|AMERICAN CONTINENTAL [101507]|1240.00||||1240.00|868|1116|260.4
100181|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 46MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|1240.00||||1240.00|533.2|1116|260.4
100181|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 46MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|1240.00||||1240.00|717.96|1116|260.4
100181|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 46MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|1240.00||||1240.00|502.2|1116|260.4
100181|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 46MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|1240.00||||1240.00|610.08|1116|260.4
100181|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 46MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|1240.00||||1240.00|1116|1116|260.4
100181|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 46MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|1240.00||||1240.00|1116|1116|260.4
100181|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 46MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|1240.00||||1240.00|806|1116|260.4
100181|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 46MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|CORESOURCE [1315]|CORESOURCE [131500]|1240.00||||1240.00|1116|1116|260.4
100181|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 46MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|1240.00||||1240.00|806|1116|260.4
100181|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 46MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|1240.00||||1240.00|1116|1116|260.4
100181|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 46MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|1240.00||||1240.00|1116|1116|260.4
100181|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 46MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|<Self-pay>|<Self-pay>|1240.00||||1240.00|372|1116|260.4
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]|1240.00||||1240.00|395.56|1116|260.4
100181|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 46MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|HEALTHNET [1495]|HEALTHNET [149500]|1240.00||||1240.00|1116|1116|260.4
100181|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 46MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|1240.00||||1240.00|1116|1116|260.4
100181|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 46MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|1240.00||||1240.00|1116|1116|260.4
100181|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 46MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|CIGNA [1260]|CIGNA - GREAT WEST [126009]|1240.00||||1240.00|868|1116|260.4
100181|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 46MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|1240.00||||1240.00|1116|1116|260.4
100181|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 46MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|1240.00||||1240.00|1116|1116|260.4
100181|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 46MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|FMH BENEFIT SERVICES [1390]|FMH [139000]|1240.00||||1240.00|1116|1116|260.4
100181|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 46MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|1240.00||||1240.00|409.2|1116|260.4
100181|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 46MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|1240.00||||1240.00|260.4|1116|260.4
100181|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 46MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|1240.00||||1240.00|620|1116|260.4
100181|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 46MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|1240.00||||1240.00|1116|1116|260.4
100181|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 46MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|SAMBA HEALTH [2305]|SAMBA HEALTH [230500]|1240.00||||1240.00|868|1116|260.4
100181|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 46MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|1240.00||||1240.00|620|1116|260.4
100181|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 46MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|1240.00||||1240.00|954.8|1116|260.4
100181|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 46MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|1240.00||||1240.00|533.2|1116|260.4
100181|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 46MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|1240.00||||1240.00|||
100181|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 46MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|UMR [2035]|UMR OPTIONS [203501]|1240.00||||1240.00|||
100181|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 46MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|1240.00||||1240.00|||
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]|1240.00||||1240.00|||
100181|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 46MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|1240.00||||1240.00|||
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]|1240.00||||1240.00|||
100181|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 46MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|GEHA [1415]|GEHA - ASA [141503]|1240.00||||1240.00|||
100181|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 46MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|1240.00||||1240.00|||
100181|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 46MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|1240.00||||1240.00|||
100181|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 46MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|AETNA [1015]|AETNA ACO WILCO [101532]|1240.00||||1240.00|||
100181|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 46MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|1240.00||||1240.00|||
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]|1240.00||||1240.00|||
100181|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 46MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|1240.00||||1240.00|||
100181|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 46MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|MULTIPLAN [1680]|HMA [168003]|1240.00||||1240.00|||
100181|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 46MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|1240.00||||1240.00|||
100181|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 46MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|1240.00||||1240.00|||
100181|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 46MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|CHAMPVA [1240]|CHAMP VA [124000]|1240.00||||1240.00|||
100181|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 46MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|1240.00||||1240.00|||
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]|1240.00||||1240.00|||
100181|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 46MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|1240.00||||1240.00|||
100181|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 46MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|1240.00||||1240.00|||
100181|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 46MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|1240.00||||1240.00|||
100181|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 46MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|1240.00||||1240.00|||
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]|1240.00||||1240.00|||
100181|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 46MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|1240.00||||1240.00|||
100181|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 46MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|1240.00||||1240.00|||
100181|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 46MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|1240.00||||1240.00|||
100181|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 46MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|1240.00||||1240.00|||
100181|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 46MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|1240.00||||1240.00|||
100184|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 47MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|1240.00||||1240.00|533.2|1116|260.4
100184|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 47MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|1240.00||||1240.00|954.8|1116|260.4
100184|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 47MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|1240.00||||1240.00|620|1116|260.4
100184|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 47MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|1240.00||||1240.00|620|1116|260.4
100184|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 47MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|1240.00||||1240.00|260.4|1116|260.4
100184|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 47MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|1240.00||||1240.00|409.2|1116|260.4
100184|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 47MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|FMH BENEFIT SERVICES [1390]|FMH [139000]|1240.00||||1240.00|1116|1116|260.4
100184|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 47MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|1240.00||||1240.00|1116|1116|260.4
100184|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 47MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|1240.00||||1240.00|1116|1116|260.4
100184|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 47MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|1240.00||||1240.00|1116|1116|260.4
100184|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 47MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|HEALTHNET [1495]|HEALTHNET [149500]|1240.00||||1240.00|1116|1116|260.4
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]|1240.00||||1240.00|395.56|1116|260.4
100184|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 47MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|1240.00||||1240.00|1116|1116|260.4
100184|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 47MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|1240.00||||1240.00|1116|1116|260.4
100184|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 47MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|1240.00||||1240.00|1116|1116|260.4
100184|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 47MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|1240.00||||1240.00|717.96|1116|260.4
100184|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 47MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|1240.00||||1240.00|533.2|1116|260.4
100184|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 47MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|1240.00||||1240.00|502.2|1116|260.4
100184|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 47MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|1240.00||||1240.00|806|1116|260.4
100184|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 47MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|CORESOURCE [1315]|CORESOURCE [131500]|1240.00||||1240.00|1116|1116|260.4
100184|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 47MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|1240.00||||1240.00|1116|1116|260.4
100184|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 47MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|1240.00||||1240.00|610.08|1116|260.4
100184|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 47MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|AETNA [1015]|COVENTRY HEALTHCARE [101502]|1240.00||||1240.00|1116|1116|260.4
100184|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 47MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|AETNA [1015]|AMERICAN CONTINENTAL [101507]|1240.00||||1240.00|868|1116|260.4
100184|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 47MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|1240.00||||1240.00|1116|1116|260.4
100184|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 47MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|MULTIPLAN [1680]|IHC HS [168011]|1240.00||||1240.00|1116|1116|260.4
100184|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 47MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|CIGNA [1260]|CIGNA - GREAT WEST [126009]|1240.00||||1240.00|868|1116|260.4
100184|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 47MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|1240.00||||1240.00|1116|1116|260.4
100184|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 47MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|1240.00||||1240.00|806|1116|260.4
100184|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 47MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|1240.00||||1240.00|806|1116|260.4
100184|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 47MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|1240.00||||1240.00|1116|1116|260.4
100184|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 47MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|<Self-pay>|<Self-pay>|1240.00||||1240.00|372|1116|260.4
100184|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 47MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|1240.00||||1240.00|1116|1116|260.4
100184|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 47MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|FIRST HEALTH [1375]|BENVEO/UCS [137512]|1240.00||||1240.00|1054|1116|260.4
100184|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 47MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|FIRST HEALTH [1375]|QUALCHOICE [137513]|1240.00||||1240.00|1116|1116|260.4
100184|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 47MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|GROUP PENSION ADMIN [1450]|GPA [145000]|1240.00||||1240.00|868|1116|260.4
100184|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 47MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|1240.00||||1240.00|1116|1116|260.4
100184|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 47MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|1240.00||||1240.00|1116|1116|260.4
100184|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 47MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|TRUSTMARK [2030]|STARMARK [203000]|1240.00||||1240.00|1116|1116|260.4
100184|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 47MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|1240.00||||1240.00|1116|1116|260.4
100184|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 47MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|1240.00||||1240.00|1116|1116|260.4
100184|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 47MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|SAMBA HEALTH [2305]|SAMBA HEALTH [230500]|1240.00||||1240.00|868|1116|260.4
100184|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 47MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|1240.00||||1240.00|||
100184|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 47MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|1240.00||||1240.00|||
100184|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 47MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|1240.00||||1240.00|||
100184|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 47MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|1240.00||||1240.00|||
100184|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 47MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|1240.00||||1240.00|||
100184|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 47MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|1240.00||||1240.00|||
100184|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 47MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|1240.00||||1240.00|||
100184|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 47MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|1240.00||||1240.00|||
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]|1240.00||||1240.00|||
100184|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 47MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|1240.00||||1240.00|||
100184|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 47MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|CHAMPVA [1240]|CHAMP VA [124000]|1240.00||||1240.00|||
100184|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 47MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|1240.00||||1240.00|||
100184|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 47MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|1240.00||||1240.00|||
100184|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 47MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|1240.00||||1240.00|||
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]|1240.00||||1240.00|||
100184|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 47MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|1240.00||||1240.00|||
100184|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 47MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|AETNA [1015]|AETNA ACO WILCO [101532]|1240.00||||1240.00|||
100184|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 47MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|MULTIPLAN [1680]|HMA [168003]|1240.00||||1240.00|||
100184|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 47MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|1240.00||||1240.00|||
100184|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 47MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|1240.00||||1240.00|||
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]|1240.00||||1240.00|||
100184|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 47MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|GEHA [1415]|GEHA - ASA [141503]|1240.00||||1240.00|||
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]|1240.00||||1240.00|||
100184|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 47MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|1240.00||||1240.00|||
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]|1240.00||||1240.00|||
100184|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 47MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|1240.00||||1240.00|||
100184|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 47MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|1240.00||||1240.00|||
100184|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 47MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|UMR [2035]|UMR OPTIONS [203501]|1240.00||||1240.00|||
100184|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 47MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|1240.00||||1240.00|||
100187|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 48MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|SAMBA HEALTH [2305]|SAMBA HEALTH [230500]|1240.00||||1240.00|868|1116|260.4
100187|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 48MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|1240.00||||1240.00|1116|1116|260.4
100187|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 48MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|TRUSTMARK [2030]|STARMARK [203000]|1240.00||||1240.00|1116|1116|260.4
100187|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 48MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|1240.00||||1240.00|1116|1116|260.4
100187|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 48MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|GROUP PENSION ADMIN [1450]|GPA [145000]|1240.00||||1240.00|868|1116|260.4
100187|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 48MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|FIRST HEALTH [1375]|QUALCHOICE [137513]|1240.00||||1240.00|1116|1116|260.4
100187|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 48MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|FIRST HEALTH [1375]|BENVEO/UCS [137512]|1240.00||||1240.00|1054|1116|260.4
100187|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 48MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|<Self-pay>|<Self-pay>|1240.00||||1240.00|372|1116|260.4
100187|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 48MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|1240.00||||1240.00|806|1116|260.4
100187|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 48MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|1240.00||||1240.00|806|1116|260.4
100187|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 48MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|MULTIPLAN [1680]|IHC HS [168011]|1240.00||||1240.00|1116|1116|260.4
100187|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 48MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|1240.00||||1240.00|1116|1116|260.4
100187|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 48MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|AETNA [1015]|COVENTRY HEALTHCARE [101502]|1240.00||||1240.00|1116|1116|260.4
100187|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 48MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|1240.00||||1240.00|717.96|1116|260.4
100187|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 48MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|1240.00||||1240.00|610.08|1116|260.4
100187|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 48MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|1240.00||||1240.00|533.2|1116|260.4
100187|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 48MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|AETNA [1015]|AMERICAN CONTINENTAL [101507]|1240.00||||1240.00|868|1116|260.4
100187|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 48MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|1240.00||||1240.00|502.2|1116|260.4
100187|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 48MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|1240.00||||1240.00|1116|1116|260.4
100187|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 48MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|1240.00||||1240.00|1116|1116|260.4
100187|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 48MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|1240.00||||1240.00|806|1116|260.4
100187|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 48MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|CORESOURCE [1315]|CORESOURCE [131500]|1240.00||||1240.00|1116|1116|260.4
100187|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 48MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|1240.00||||1240.00|1116|1116|260.4
100187|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 48MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|1240.00||||1240.00|1116|1116|260.4
100187|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 48MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|1240.00||||1240.00|1116|1116|260.4
100187|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 48MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|1240.00||||1240.00|1116|1116|260.4
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]|1240.00||||1240.00|395.56|1116|260.4
100187|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 48MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|HEALTHNET [1495]|HEALTHNET [149500]|1240.00||||1240.00|1116|1116|260.4
100187|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 48MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|1240.00||||1240.00|1116|1116|260.4
100187|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 48MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|1240.00||||1240.00|1116|1116|260.4
100187|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 48MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|1240.00||||1240.00|1116|1116|260.4
100187|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 48MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|CIGNA [1260]|CIGNA - GREAT WEST [126009]|1240.00||||1240.00|868|1116|260.4
100187|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 48MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|1240.00||||1240.00|1116|1116|260.4
100187|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 48MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|FMH BENEFIT SERVICES [1390]|FMH [139000]|1240.00||||1240.00|1116|1116|260.4
100187|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 48MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|1240.00||||1240.00|1116|1116|260.4
100187|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 48MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|1240.00||||1240.00|409.2|1116|260.4
100187|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 48MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|1240.00||||1240.00|260.4|1116|260.4
100187|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 48MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|1240.00||||1240.00|620|1116|260.4
100187|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 48MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|1240.00||||1240.00|1116|1116|260.4
100187|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 48MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|1240.00||||1240.00|620|1116|260.4
100187|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 48MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|1240.00||||1240.00|954.8|1116|260.4
100187|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 48MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|1240.00||||1240.00|533.2|1116|260.4
100187|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 48MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|1240.00||||1240.00|||
100187|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 48MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|UMR [2035]|UMR OPTIONS [203501]|1240.00||||1240.00|||
100187|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 48MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|1240.00||||1240.00|||
100187|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 48MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|1240.00||||1240.00|||
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]|1240.00||||1240.00|||
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]|1240.00||||1240.00|||
100187|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 48MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|GEHA [1415]|GEHA - ASA [141503]|1240.00||||1240.00|||
100187|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 48MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|1240.00||||1240.00|||
100187|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 48MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|MULTIPLAN [1680]|HMA [168003]|1240.00||||1240.00|||
100187|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 48MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|1240.00||||1240.00|||
100187|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 48MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|1240.00||||1240.00|||
100187|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 48MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|AETNA [1015]|AETNA ACO WILCO [101532]|1240.00||||1240.00|||
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]|1240.00||||1240.00|||
100187|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 48MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|1240.00||||1240.00|||
100187|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 48MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|1240.00||||1240.00|||
100187|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 48MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|1240.00||||1240.00|||
100187|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 48MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|CHAMPVA [1240]|CHAMP VA [124000]|1240.00||||1240.00|||
100187|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 48MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|1240.00||||1240.00|||
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]|1240.00||||1240.00|||
100187|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 48MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|1240.00||||1240.00|||
100187|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 48MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|1240.00||||1240.00|||
100187|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 48MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|1240.00||||1240.00|||
100187|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 48MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|1240.00||||1240.00|||
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]|1240.00||||1240.00|||
100187|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 48MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|1240.00||||1240.00|||
100187|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 48MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|1240.00||||1240.00|||
100187|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 48MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|1240.00||||1240.00|||
100187|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 48MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|1240.00||||1240.00|||
100187|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 48MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|1240.00||||1240.00|||
10019|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L16 MM OD2.7 MM ODSEC5 MM CORTEX SELF TAP SPHERICAL HEAD SMALL HEXAGONAL SOCKET NONSTERILE MODULAR MINI FRAGMENT SET|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|183.00||||183.00|78.69|164.7|38.43
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|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|183.00||||183.00|140.91|164.7|38.43
10019|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L16 MM OD2.7 MM ODSEC5 MM CORTEX SELF TAP SPHERICAL HEAD SMALL HEXAGONAL SOCKET NONSTERILE MODULAR MINI FRAGMENT SET|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|183.00||||183.00|91.5|164.7|38.43
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 TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|183.00||||183.00|164.7|164.7|38.43
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|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|183.00||||183.00|38.43|164.7|38.43
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]|183.00||||183.00|60.39|164.7|38.43
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|FMH BENEFIT SERVICES [1390]|FMH [139000]|183.00||||183.00|164.7|164.7|38.43
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 - GREAT WEST [126009]|183.00||||183.00|128.1|164.7|38.43
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]|183.00||||183.00|164.7|164.7|38.43
10019|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L16 MM OD2.7 MM ODSEC5 MM CORTEX SELF TAP SPHERICAL HEAD SMALL HEXAGONAL SOCKET NONSTERILE MODULAR MINI FRAGMENT SET|HEALTHNET [1495]|HEALTHNET [149500]|183.00||||183.00|164.7|164.7|38.43
10019|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L16 MM OD2.7 MM ODSEC5 MM CORTEX SELF TAP SPHERICAL HEAD SMALL HEXAGONAL SOCKET NONSTERILE MODULAR MINI FRAGMENT SET|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|183.00||||183.00|164.7|164.7|38.43
10019|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L16 MM OD2.7 MM ODSEC5 MM CORTEX SELF TAP SPHERICAL HEAD SMALL HEXAGONAL SOCKET NONSTERILE MODULAR MINI FRAGMENT SET|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|183.00||||183.00|164.7|164.7|38.43
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|CORESOURCE [1315]|CORESOURCE [131500]|183.00||||183.00|164.7|164.7|38.43
10019|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L16 MM OD2.7 MM ODSEC5 MM CORTEX SELF TAP SPHERICAL HEAD SMALL HEXAGONAL SOCKET NONSTERILE MODULAR MINI FRAGMENT SET|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|183.00||||183.00|164.7|164.7|38.43
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|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|183.00||||183.00|118.95|164.7|38.43
10019|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L16 MM OD2.7 MM ODSEC5 MM CORTEX SELF TAP SPHERICAL HEAD SMALL HEXAGONAL SOCKET NONSTERILE MODULAR MINI FRAGMENT SET|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|183.00||||183.00|164.7|164.7|38.43
10019|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L16 MM OD2.7 MM ODSEC5 MM CORTEX SELF TAP SPHERICAL HEAD SMALL HEXAGONAL SOCKET NONSTERILE MODULAR MINI FRAGMENT SET|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|183.00||||183.00|164.7|164.7|38.43
10019|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L16 MM OD2.7 MM ODSEC5 MM CORTEX SELF TAP SPHERICAL HEAD SMALL HEXAGONAL SOCKET NONSTERILE MODULAR MINI FRAGMENT SET|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|183.00||||183.00|78.69|164.7|38.43
10019|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L16 MM OD2.7 MM ODSEC5 MM CORTEX SELF TAP SPHERICAL HEAD SMALL HEXAGONAL SOCKET NONSTERILE MODULAR MINI FRAGMENT SET|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|183.00||||183.00|105.96|164.7|38.43
10019|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L16 MM OD2.7 MM ODSEC5 MM CORTEX SELF TAP SPHERICAL HEAD SMALL HEXAGONAL SOCKET NONSTERILE MODULAR MINI FRAGMENT SET|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|183.00||||183.00|74.12|164.7|38.43
10019|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L16 MM OD2.7 MM ODSEC5 MM CORTEX SELF TAP SPHERICAL HEAD SMALL HEXAGONAL SOCKET NONSTERILE MODULAR MINI FRAGMENT SET|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|183.00||||183.00|90.04|164.7|38.43
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 HEALTH CARE [132000]|183.00||||183.00|164.7|164.7|38.43
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]|183.00||||183.00|58.38|164.7|38.43
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]|COVENTRY HEALTHCARE [101502]|183.00||||183.00|164.7|164.7|38.43
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]|AMERICAN CONTINENTAL [101507]|183.00||||183.00|128.1|164.7|38.43
10019|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L16 MM OD2.7 MM ODSEC5 MM CORTEX SELF TAP SPHERICAL HEAD SMALL HEXAGONAL SOCKET NONSTERILE MODULAR MINI FRAGMENT SET|MULTIPLAN [1680]|IHC HS [168011]|183.00||||183.00|164.7|164.7|38.43
10019|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L16 MM OD2.7 MM ODSEC5 MM CORTEX SELF TAP SPHERICAL HEAD SMALL HEXAGONAL SOCKET NONSTERILE MODULAR MINI FRAGMENT SET|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|183.00||||183.00|164.7|164.7|38.43
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|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|183.00||||183.00|118.95|164.7|38.43
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|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|183.00||||183.00|118.95|164.7|38.43
10019|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L16 MM OD2.7 MM ODSEC5 MM CORTEX SELF TAP SPHERICAL HEAD SMALL HEXAGONAL SOCKET NONSTERILE MODULAR MINI FRAGMENT SET|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|183.00||||183.00|164.7|164.7|38.43
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 MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|183.00||||183.00|164.7|164.7|38.43
10019|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L16 MM OD2.7 MM ODSEC5 MM CORTEX SELF TAP SPHERICAL HEAD SMALL HEXAGONAL SOCKET NONSTERILE MODULAR MINI FRAGMENT SET|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|183.00||||183.00|91.5|164.7|38.43
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>|183.00||||183.00|54.9|164.7|38.43
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]|BENVEO/UCS [137512]|183.00||||183.00|155.55|164.7|38.43
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]|QUALCHOICE [137513]|183.00||||183.00|164.7|164.7|38.43
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|GROUP PENSION ADMIN [1450]|GPA [145000]|183.00||||183.00|128.1|164.7|38.43
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|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|183.00||||183.00|164.7|164.7|38.43
10019|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L16 MM OD2.7 MM ODSEC5 MM CORTEX SELF TAP SPHERICAL HEAD SMALL HEXAGONAL SOCKET NONSTERILE MODULAR MINI FRAGMENT SET|TRUSTMARK [2030]|STARMARK [203000]|183.00||||183.00|164.7|164.7|38.43
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|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|183.00||||183.00|164.7|164.7|38.43
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|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|183.00||||183.00|164.7|164.7|38.43
10019|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L16 MM OD2.7 MM ODSEC5 MM CORTEX SELF TAP SPHERICAL HEAD SMALL HEXAGONAL SOCKET NONSTERILE MODULAR MINI FRAGMENT SET|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|183.00||||183.00|164.7|164.7|38.43
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|SAMBA HEALTH [2305]|SAMBA HEALTH [230500]|183.00||||183.00|128.1|164.7|38.43
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|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|183.00||||183.00|||
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 MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|183.00||||183.00|||
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 MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|183.00||||183.00|||
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 IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|183.00||||183.00|||
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]|183.00||||183.00|||
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|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|183.00||||183.00|||
10019|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L16 MM OD2.7 MM ODSEC5 MM CORTEX SELF TAP SPHERICAL HEAD SMALL HEXAGONAL SOCKET NONSTERILE MODULAR MINI FRAGMENT SET|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|183.00||||183.00|||
10019|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L16 MM OD2.7 MM ODSEC5 MM CORTEX SELF TAP SPHERICAL HEAD SMALL HEXAGONAL SOCKET NONSTERILE MODULAR MINI FRAGMENT SET|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|183.00||||183.00|||
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]|183.00||||183.00|||
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]|183.00||||183.00|||
10019|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L16 MM OD2.7 MM ODSEC5 MM CORTEX SELF TAP SPHERICAL HEAD SMALL HEXAGONAL SOCKET NONSTERILE MODULAR MINI FRAGMENT SET|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|183.00||||183.00|||
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|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|183.00||||183.00|||
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]|183.00||||183.00|||
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|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|183.00||||183.00|||
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|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|183.00||||183.00|||
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]|183.00||||183.00|||
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 MEDICARE SUPPLEMENT [101514]|183.00||||183.00|||
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]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|183.00||||183.00|||
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]|183.00||||183.00|||
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|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|183.00||||183.00|||
10019|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L16 MM OD2.7 MM ODSEC5 MM CORTEX SELF TAP SPHERICAL HEAD SMALL HEXAGONAL SOCKET NONSTERILE MODULAR MINI FRAGMENT SET|GEHA [1415]|GEHA - ASA [141503]|183.00||||183.00|||
10019|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L16 MM OD2.7 MM ODSEC5 MM CORTEX SELF TAP SPHERICAL HEAD SMALL HEXAGONAL SOCKET NONSTERILE MODULAR MINI FRAGMENT SET|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|183.00||||183.00|||
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]|183.00||||183.00|||
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|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|183.00||||183.00|||
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]|183.00||||183.00|||
10019|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L16 MM OD2.7 MM ODSEC5 MM CORTEX SELF TAP SPHERICAL HEAD SMALL HEXAGONAL SOCKET NONSTERILE MODULAR MINI FRAGMENT SET|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|183.00||||183.00|||
10019|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L16 MM OD2.7 MM ODSEC5 MM CORTEX SELF TAP SPHERICAL HEAD SMALL HEXAGONAL SOCKET NONSTERILE MODULAR MINI FRAGMENT SET|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|183.00||||183.00|||
10019|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L16 MM OD2.7 MM ODSEC5 MM CORTEX SELF TAP SPHERICAL HEAD SMALL HEXAGONAL SOCKET NONSTERILE MODULAR MINI FRAGMENT SET|UMR [2035]|UMR OPTIONS [203501]|183.00||||183.00|||
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|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|183.00||||183.00|||
100191|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 49MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|1240.00||||1240.00|1116|1116|260.4
100191|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 49MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|TRUSTMARK [2030]|STARMARK [203000]|1240.00||||1240.00|1116|1116|260.4
100191|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 49MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|1240.00||||1240.00|1116|1116|260.4
100191|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 49MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|1240.00||||1240.00|1116|1116|260.4
100191|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 49MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|GROUP PENSION ADMIN [1450]|GPA [145000]|1240.00||||1240.00|868|1116|260.4
100191|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 49MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|FIRST HEALTH [1375]|BENVEO/UCS [137512]|1240.00||||1240.00|1054|1116|260.4
100191|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 49MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|1240.00||||1240.00|1116|1116|260.4
100191|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 49MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|1240.00||||1240.00|806|1116|260.4
100191|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 49MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|1240.00||||1240.00|1116|1116|260.4
100191|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 49MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|MULTIPLAN [1680]|IHC HS [168011]|1240.00||||1240.00|1116|1116|260.4
100191|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 49MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|1240.00||||1240.00|1116|1116|260.4
100191|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 49MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|AETNA [1015]|COVENTRY HEALTHCARE [101502]|1240.00||||1240.00|1116|1116|260.4
100191|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 49MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|1240.00||||1240.00|610.08|1116|260.4
100191|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 49MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|1240.00||||1240.00|533.2|1116|260.4
100191|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 49MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|1240.00||||1240.00|717.96|1116|260.4
100191|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 49MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|1240.00||||1240.00|502.2|1116|260.4
100191|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 49MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|AETNA [1015]|AMERICAN CONTINENTAL [101507]|1240.00||||1240.00|868|1116|260.4
100191|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 49MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|1240.00||||1240.00|1116|1116|260.4
100191|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 49MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|1240.00||||1240.00|1116|1116|260.4
100191|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 49MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|1240.00||||1240.00|806|1116|260.4
100191|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 49MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|CORESOURCE [1315]|CORESOURCE [131500]|1240.00||||1240.00|1116|1116|260.4
100191|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 49MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|1240.00||||1240.00|806|1116|260.4
100191|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 49MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|1240.00||||1240.00|1116|1116|260.4
100191|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 49MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|1240.00||||1240.00|1116|1116|260.4
100191|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 49MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|<Self-pay>|<Self-pay>|1240.00||||1240.00|372|1116|260.4
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]|1240.00||||1240.00|395.56|1116|260.4
100191|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 49MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|HEALTHNET [1495]|HEALTHNET [149500]|1240.00||||1240.00|1116|1116|260.4
100191|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 49MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|FIRST HEALTH [1375]|QUALCHOICE [137513]|1240.00||||1240.00|1116|1116|260.4
100191|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 49MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|1240.00||||1240.00|1116|1116|260.4
100191|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 49MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|1240.00||||1240.00|1116|1116|260.4
100191|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 49MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|CIGNA [1260]|CIGNA - GREAT WEST [126009]|1240.00||||1240.00|868|1116|260.4
100191|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 49MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|1240.00||||1240.00|1116|1116|260.4
100191|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 49MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|FMH BENEFIT SERVICES [1390]|FMH [139000]|1240.00||||1240.00|1116|1116|260.4
100191|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 49MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|1240.00||||1240.00|409.2|1116|260.4
100191|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 49MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|1240.00||||1240.00|1116|1116|260.4
100191|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 49MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|SAMBA HEALTH [2305]|SAMBA HEALTH [230500]|1240.00||||1240.00|868|1116|260.4
100191|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 49MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|1240.00||||1240.00|260.4|1116|260.4
100191|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 49MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|1240.00||||1240.00|620|1116|260.4
100191|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 49MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|1240.00||||1240.00|1116|1116|260.4
100191|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 49MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|1240.00||||1240.00|620|1116|260.4
100191|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 49MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|1240.00||||1240.00|954.8|1116|260.4
100191|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 49MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|1240.00||||1240.00|533.2|1116|260.4
100191|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 49MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|1240.00||||1240.00|||
100191|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 49MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|UMR [2035]|UMR OPTIONS [203501]|1240.00||||1240.00|||
100191|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 49MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|1240.00||||1240.00|||
100191|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 49MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|1240.00||||1240.00|||
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]|1240.00||||1240.00|||
100191|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 49MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|1240.00||||1240.00|||
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]|1240.00||||1240.00|||
100191|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 49MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|GEHA [1415]|GEHA - ASA [141503]|1240.00||||1240.00|||
100191|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 49MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|1240.00||||1240.00|||
100191|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 49MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|1240.00||||1240.00|||
100191|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 49MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|MULTIPLAN [1680]|HMA [168003]|1240.00||||1240.00|||
100191|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 49MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|AETNA [1015]|AETNA ACO WILCO [101532]|1240.00||||1240.00|||
100191|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 49MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|1240.00||||1240.00|||
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]|1240.00||||1240.00|||
100191|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 49MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|1240.00||||1240.00|||
100191|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 49MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|1240.00||||1240.00|||
100191|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 49MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|1240.00||||1240.00|||
100191|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 49MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|CHAMPVA [1240]|CHAMP VA [124000]|1240.00||||1240.00|||
100191|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 49MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|1240.00||||1240.00|||
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]|1240.00||||1240.00|||
100191|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 49MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|1240.00||||1240.00|||
100191|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 49MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|1240.00||||1240.00|||
100191|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 49MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|1240.00||||1240.00|||
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]|1240.00||||1240.00|||
100191|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 49MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|1240.00||||1240.00|||
100191|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 49MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|1240.00||||1240.00|||
100191|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 49MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|1240.00||||1240.00|||
100191|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 49MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|1240.00||||1240.00|||
100191|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 49MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|1240.00||||1240.00|||
100195|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 50MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|1240.00||||1240.00|533.2|1116|260.4
100195|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 50MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|1240.00||||1240.00|620|1116|260.4
100195|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 50MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|1240.00||||1240.00|620|1116|260.4
100195|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 50MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|1240.00||||1240.00|260.4|1116|260.4
100195|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 50MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|1240.00||||1240.00|409.2|1116|260.4
100195|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 50MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|FMH BENEFIT SERVICES [1390]|FMH [139000]|1240.00||||1240.00|1116|1116|260.4
100195|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 50MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|1240.00||||1240.00|1116|1116|260.4
100195|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 50MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|CIGNA [1260]|CIGNA - GREAT WEST [126009]|1240.00||||1240.00|868|1116|260.4
100195|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 50MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|1240.00||||1240.00|1116|1116|260.4
100195|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 50MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|1240.00||||1240.00|1116|1116|260.4
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]|1240.00||||1240.00|395.56|1116|260.4
100195|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 50MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|1240.00||||1240.00|1116|1116|260.4
100195|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 50MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|1240.00||||1240.00|806|1116|260.4
100195|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 50MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|1240.00||||1240.00|1116|1116|260.4
100195|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 50MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|1240.00||||1240.00|1116|1116|260.4
100195|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 50MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|1240.00||||1240.00|610.08|1116|260.4
100195|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 50MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|1240.00||||1240.00|502.2|1116|260.4
100195|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 50MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|1240.00||||1240.00|533.2|1116|260.4
100195|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 50MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|CORESOURCE [1315]|CORESOURCE [131500]|1240.00||||1240.00|1116|1116|260.4
100195|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 50MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|1240.00||||1240.00|717.96|1116|260.4
100195|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 50MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|AETNA [1015]|AMERICAN CONTINENTAL [101507]|1240.00||||1240.00|868|1116|260.4
100195|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 50MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|1240.00||||1240.00|1116|1116|260.4
100195|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 50MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|HEALTHNET [1495]|HEALTHNET [149500]|1240.00||||1240.00|1116|1116|260.4
100195|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 50MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|AETNA [1015]|COVENTRY HEALTHCARE [101502]|1240.00||||1240.00|1116|1116|260.4
100195|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 50MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|1240.00||||1240.00|1116|1116|260.4
100195|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 50MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|MULTIPLAN [1680]|IHC HS [168011]|1240.00||||1240.00|1116|1116|260.4
100195|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 50MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|1240.00||||1240.00|1116|1116|260.4
100195|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 50MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|1240.00||||1240.00|806|1116|260.4
100195|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 50MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|1240.00||||1240.00|806|1116|260.4
100195|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 50MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|1240.00||||1240.00|1116|1116|260.4
100195|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 50MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|<Self-pay>|<Self-pay>|1240.00||||1240.00|372|1116|260.4
100195|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 50MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|1240.00||||1240.00|1116|1116|260.4
100195|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 50MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|FIRST HEALTH [1375]|BENVEO/UCS [137512]|1240.00||||1240.00|1054|1116|260.4
100195|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 50MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|FIRST HEALTH [1375]|QUALCHOICE [137513]|1240.00||||1240.00|1116|1116|260.4
100195|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 50MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|1240.00||||1240.00|954.8|1116|260.4
100195|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 50MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|GROUP PENSION ADMIN [1450]|GPA [145000]|1240.00||||1240.00|868|1116|260.4
100195|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 50MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|1240.00||||1240.00|1116|1116|260.4
100195|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 50MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|1240.00||||1240.00|1116|1116|260.4
100195|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 50MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|TRUSTMARK [2030]|STARMARK [203000]|1240.00||||1240.00|1116|1116|260.4
100195|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 50MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|1240.00||||1240.00|1116|1116|260.4
100195|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 50MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|1240.00||||1240.00|1116|1116|260.4
100195|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 50MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|SAMBA HEALTH [2305]|SAMBA HEALTH [230500]|1240.00||||1240.00|868|1116|260.4
100195|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 50MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|1240.00||||1240.00|||
100195|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 50MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|1240.00||||1240.00|||
100195|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 50MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|1240.00||||1240.00|||
100195|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 50MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|1240.00||||1240.00|||
100195|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 50MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|1240.00||||1240.00|||
100195|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 50MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|1240.00||||1240.00|||
100195|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 50MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|1240.00||||1240.00|||
100195|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 50MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|1240.00||||1240.00|||
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]|1240.00||||1240.00|||
100195|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 50MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|1240.00||||1240.00|||
100195|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 50MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|CHAMPVA [1240]|CHAMP VA [124000]|1240.00||||1240.00|||
100195|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 50MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|1240.00||||1240.00|||
100195|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 50MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|1240.00||||1240.00|||
100195|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 50MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|1240.00||||1240.00|||
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]|1240.00||||1240.00|||
100195|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 50MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|AETNA [1015]|AETNA ACO WILCO [101532]|1240.00||||1240.00|||
100195|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 50MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|1240.00||||1240.00|||
100195|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 50MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|MULTIPLAN [1680]|HMA [168003]|1240.00||||1240.00|||
100195|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 50MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|1240.00||||1240.00|||
100195|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 50MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|1240.00||||1240.00|||
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]|1240.00||||1240.00|||
100195|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 50MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|GEHA [1415]|GEHA - ASA [141503]|1240.00||||1240.00|||
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]|1240.00||||1240.00|||
100195|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 50MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|1240.00||||1240.00|||
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]|1240.00||||1240.00|||
100195|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 50MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|1240.00||||1240.00|||
100195|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 50MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|1240.00||||1240.00|||
100195|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 50MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|UMR [2035]|UMR OPTIONS [203501]|1240.00||||1240.00|||
100195|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 50MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|1240.00||||1240.00|||
100199|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 51MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|SAMBA HEALTH [2305]|SAMBA HEALTH [230500]|1240.00||||1240.00|868|1116|260.4
100199|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 51MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|1240.00||||1240.00|1116|1116|260.4
100199|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 51MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|1240.00||||1240.00|1116|1116|260.4
100199|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 51MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|TRUSTMARK [2030]|STARMARK [203000]|1240.00||||1240.00|1116|1116|260.4
100199|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 51MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|1240.00||||1240.00|1116|1116|260.4
100199|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 51MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|1240.00||||1240.00|1116|1116|260.4
100199|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 51MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|FIRST HEALTH [1375]|QUALCHOICE [137513]|1240.00||||1240.00|1116|1116|260.4
100199|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 51MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|FIRST HEALTH [1375]|BENVEO/UCS [137512]|1240.00||||1240.00|1054|1116|260.4
100199|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 51MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|<Self-pay>|<Self-pay>|1240.00||||1240.00|372|1116|260.4
100199|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 51MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|1240.00||||1240.00|806|1116|260.4
100199|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 51MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|1240.00||||1240.00|806|1116|260.4
100199|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 51MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|1240.00||||1240.00|1116|1116|260.4
100199|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 51MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|MULTIPLAN [1680]|IHC HS [168011]|1240.00||||1240.00|1116|1116|260.4
100199|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 51MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|AETNA [1015]|AMERICAN CONTINENTAL [101507]|1240.00||||1240.00|868|1116|260.4
100199|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 51MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|1240.00||||1240.00|533.2|1116|260.4
100199|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 51MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|1240.00||||1240.00|502.2|1116|260.4
100199|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 51MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|1240.00||||1240.00|610.08|1116|260.4
100199|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 51MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|AETNA [1015]|COVENTRY HEALTHCARE [101502]|1240.00||||1240.00|1116|1116|260.4
100199|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 51MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|1240.00||||1240.00|717.96|1116|260.4
100199|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 51MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|1240.00||||1240.00|1116|1116|260.4
100199|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 51MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|1240.00||||1240.00|1116|1116|260.4
100199|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 51MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|1240.00||||1240.00|1116|1116|260.4
100199|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 51MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|1240.00||||1240.00|806|1116|260.4
100199|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 51MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|CORESOURCE [1315]|CORESOURCE [131500]|1240.00||||1240.00|1116|1116|260.4
100199|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 51MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|1240.00||||1240.00|1116|1116|260.4
100199|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 51MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|1240.00||||1240.00|1116|1116|260.4
100199|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 51MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|1240.00||||1240.00|1116|1116|260.4
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]|1240.00||||1240.00|395.56|1116|260.4
100199|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 51MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|GROUP PENSION ADMIN [1450]|GPA [145000]|1240.00||||1240.00|868|1116|260.4
100199|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 51MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|HEALTHNET [1495]|HEALTHNET [149500]|1240.00||||1240.00|1116|1116|260.4
100199|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 51MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|1240.00||||1240.00|1116|1116|260.4
100199|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 51MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|1240.00||||1240.00|1116|1116|260.4
100199|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 51MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|CIGNA [1260]|CIGNA - GREAT WEST [126009]|1240.00||||1240.00|868|1116|260.4
100199|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 51MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|1240.00||||1240.00|1116|1116|260.4
100199|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 51MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|FMH BENEFIT SERVICES [1390]|FMH [139000]|1240.00||||1240.00|1116|1116|260.4
100199|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 51MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|1240.00||||1240.00|409.2|1116|260.4
100199|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 51MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|1240.00||||1240.00|260.4|1116|260.4
100199|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 51MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|1240.00||||1240.00|620|1116|260.4
100199|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 51MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|1240.00||||1240.00|1116|1116|260.4
100199|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 51MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|1240.00||||1240.00|620|1116|260.4
100199|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 51MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|1240.00||||1240.00|954.8|1116|260.4
100199|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 51MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|1240.00||||1240.00|533.2|1116|260.4
100199|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 51MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|1240.00||||1240.00|||
100199|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 51MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|UMR [2035]|UMR OPTIONS [203501]|1240.00||||1240.00|||
100199|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 51MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|1240.00||||1240.00|||
100199|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 51MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|1240.00||||1240.00|||
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]|1240.00||||1240.00|||
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]|1240.00||||1240.00|||
100199|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 51MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|GEHA [1415]|GEHA - ASA [141503]|1240.00||||1240.00|||
100199|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 51MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|1240.00||||1240.00|||
100199|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 51MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|1240.00||||1240.00|||
100199|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 51MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|MULTIPLAN [1680]|HMA [168003]|1240.00||||1240.00|||
100199|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 51MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|AETNA [1015]|AETNA ACO WILCO [101532]|1240.00||||1240.00|||
100199|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 51MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|1240.00||||1240.00|||
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]|1240.00||||1240.00|||
100199|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 51MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|1240.00||||1240.00|||
100199|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 51MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|1240.00||||1240.00|||
100199|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 51MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|1240.00||||1240.00|||
100199|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 51MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|CHAMPVA [1240]|CHAMP VA [124000]|1240.00||||1240.00|||
100199|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 51MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|1240.00||||1240.00|||
100199|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 51MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|1240.00||||1240.00|||
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]|1240.00||||1240.00|||
100199|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 51MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|1240.00||||1240.00|||
100199|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 51MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|1240.00||||1240.00|||
100199|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 51MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|1240.00||||1240.00|||
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]|1240.00||||1240.00|||
100199|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 51MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|1240.00||||1240.00|||
100199|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 51MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|1240.00||||1240.00|||
100199|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 51MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|1240.00||||1240.00|||
100199|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 51MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|1240.00||||1240.00|||
100199|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 51MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|1240.00||||1240.00|||
10020|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L18 MM OD2.7 MM ODSEC5 MM CORTEX SELF TAP SPHERICAL HEAD SMALL HEXAGONAL SOCKET NONSTERILE MODULAR MINI FRAGMENT SET|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|183.00||||183.00|78.69|164.7|38.43
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|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|183.00||||183.00|140.91|164.7|38.43
10020|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L18 MM OD2.7 MM ODSEC5 MM CORTEX SELF TAP SPHERICAL HEAD SMALL HEXAGONAL SOCKET NONSTERILE MODULAR MINI FRAGMENT SET|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|183.00||||183.00|91.5|164.7|38.43
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 TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|183.00||||183.00|164.7|164.7|38.43
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|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|183.00||||183.00|38.43|164.7|38.43
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]|183.00||||183.00|60.39|164.7|38.43
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 MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|183.00||||183.00|164.7|164.7|38.43
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|FMH BENEFIT SERVICES [1390]|FMH [139000]|183.00||||183.00|164.7|164.7|38.43
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 - GREAT WEST [126009]|183.00||||183.00|128.1|164.7|38.43
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]|183.00||||183.00|164.7|164.7|38.43
10020|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L18 MM OD2.7 MM ODSEC5 MM CORTEX SELF TAP SPHERICAL HEAD SMALL HEXAGONAL SOCKET NONSTERILE MODULAR MINI FRAGMENT SET|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|183.00||||183.00|164.7|164.7|38.43
10020|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L18 MM OD2.7 MM ODSEC5 MM CORTEX SELF TAP SPHERICAL HEAD SMALL HEXAGONAL SOCKET NONSTERILE MODULAR MINI FRAGMENT SET|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|183.00||||183.00|164.7|164.7|38.43
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|CORESOURCE [1315]|CORESOURCE [131500]|183.00||||183.00|164.7|164.7|38.43
10020|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L18 MM OD2.7 MM ODSEC5 MM CORTEX SELF TAP SPHERICAL HEAD SMALL HEXAGONAL SOCKET NONSTERILE MODULAR MINI FRAGMENT SET|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|183.00||||183.00|164.7|164.7|38.43
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|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|183.00||||183.00|118.95|164.7|38.43
10020|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L18 MM OD2.7 MM ODSEC5 MM CORTEX SELF TAP SPHERICAL HEAD SMALL HEXAGONAL SOCKET NONSTERILE MODULAR MINI FRAGMENT SET|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|183.00||||183.00|164.7|164.7|38.43
10020|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L18 MM OD2.7 MM ODSEC5 MM CORTEX SELF TAP SPHERICAL HEAD SMALL HEXAGONAL SOCKET NONSTERILE MODULAR MINI FRAGMENT SET|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|183.00||||183.00|164.7|164.7|38.43
10020|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L18 MM OD2.7 MM ODSEC5 MM CORTEX SELF TAP SPHERICAL HEAD SMALL HEXAGONAL SOCKET NONSTERILE MODULAR MINI FRAGMENT SET|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|183.00||||183.00|74.12|164.7|38.43
10020|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L18 MM OD2.7 MM ODSEC5 MM CORTEX SELF TAP SPHERICAL HEAD SMALL HEXAGONAL SOCKET NONSTERILE MODULAR MINI FRAGMENT SET|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|183.00||||183.00|78.69|164.7|38.43
10020|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L18 MM OD2.7 MM ODSEC5 MM CORTEX SELF TAP SPHERICAL HEAD SMALL HEXAGONAL SOCKET NONSTERILE MODULAR MINI FRAGMENT SET|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|183.00||||183.00|90.04|164.7|38.43
10020|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L18 MM OD2.7 MM ODSEC5 MM CORTEX SELF TAP SPHERICAL HEAD SMALL HEXAGONAL SOCKET NONSTERILE MODULAR MINI FRAGMENT SET|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|183.00||||183.00|105.96|164.7|38.43
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 HEALTH CARE [132000]|183.00||||183.00|164.7|164.7|38.43
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]|COVENTRY HEALTHCARE [101502]|183.00||||183.00|164.7|164.7|38.43
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]|183.00||||183.00|58.38|164.7|38.43
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]|AMERICAN CONTINENTAL [101507]|183.00||||183.00|128.1|164.7|38.43
10020|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L18 MM OD2.7 MM ODSEC5 MM CORTEX SELF TAP SPHERICAL HEAD SMALL HEXAGONAL SOCKET NONSTERILE MODULAR MINI FRAGMENT SET|MULTIPLAN [1680]|IHC HS [168011]|183.00||||183.00|164.7|164.7|38.43
10020|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L18 MM OD2.7 MM ODSEC5 MM CORTEX SELF TAP SPHERICAL HEAD SMALL HEXAGONAL SOCKET NONSTERILE MODULAR MINI FRAGMENT SET|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|183.00||||183.00|164.7|164.7|38.43
10020|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L18 MM OD2.7 MM ODSEC5 MM CORTEX SELF TAP SPHERICAL HEAD SMALL HEXAGONAL SOCKET NONSTERILE MODULAR MINI FRAGMENT SET|HEALTHNET [1495]|HEALTHNET [149500]|183.00||||183.00|164.7|164.7|38.43
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|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|183.00||||183.00|118.95|164.7|38.43
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|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|183.00||||183.00|118.95|164.7|38.43
10020|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L18 MM OD2.7 MM ODSEC5 MM CORTEX SELF TAP SPHERICAL HEAD SMALL HEXAGONAL SOCKET NONSTERILE MODULAR MINI FRAGMENT SET|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|183.00||||183.00|164.7|164.7|38.43
10020|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L18 MM OD2.7 MM ODSEC5 MM CORTEX SELF TAP SPHERICAL HEAD SMALL HEXAGONAL SOCKET NONSTERILE MODULAR MINI FRAGMENT SET|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|183.00||||183.00|91.5|164.7|38.43
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>|183.00||||183.00|54.9|164.7|38.43
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]|QUALCHOICE [137513]|183.00||||183.00|164.7|164.7|38.43
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]|BENVEO/UCS [137512]|183.00||||183.00|155.55|164.7|38.43
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|GROUP PENSION ADMIN [1450]|GPA [145000]|183.00||||183.00|128.1|164.7|38.43
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|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|183.00||||183.00|164.7|164.7|38.43
10020|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L18 MM OD2.7 MM ODSEC5 MM CORTEX SELF TAP SPHERICAL HEAD SMALL HEXAGONAL SOCKET NONSTERILE MODULAR MINI FRAGMENT SET|TRUSTMARK [2030]|STARMARK [203000]|183.00||||183.00|164.7|164.7|38.43
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|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|183.00||||183.00|164.7|164.7|38.43
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|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|183.00||||183.00|164.7|164.7|38.43
10020|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L18 MM OD2.7 MM ODSEC5 MM CORTEX SELF TAP SPHERICAL HEAD SMALL HEXAGONAL SOCKET NONSTERILE MODULAR MINI FRAGMENT SET|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|183.00||||183.00|164.7|164.7|38.43
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|SAMBA HEALTH [2305]|SAMBA HEALTH [230500]|183.00||||183.00|128.1|164.7|38.43
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|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|183.00||||183.00|||
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 MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|183.00||||183.00|||
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 IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|183.00||||183.00|||
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]|183.00||||183.00|||
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|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|183.00||||183.00|||
10020|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L18 MM OD2.7 MM ODSEC5 MM CORTEX SELF TAP SPHERICAL HEAD SMALL HEXAGONAL SOCKET NONSTERILE MODULAR MINI FRAGMENT SET|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|183.00||||183.00|||
10020|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L18 MM OD2.7 MM ODSEC5 MM CORTEX SELF TAP SPHERICAL HEAD SMALL HEXAGONAL SOCKET NONSTERILE MODULAR MINI FRAGMENT SET|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|183.00||||183.00|||
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]|183.00||||183.00|||
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]|183.00||||183.00|||
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|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|183.00||||183.00|||
10020|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L18 MM OD2.7 MM ODSEC5 MM CORTEX SELF TAP SPHERICAL HEAD SMALL HEXAGONAL SOCKET NONSTERILE MODULAR MINI FRAGMENT SET|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|183.00||||183.00|||
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|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|183.00||||183.00|||
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]|183.00||||183.00|||
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|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|183.00||||183.00|||
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 MEDICARE SUPPLEMENT [101514]|183.00||||183.00|||
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]|183.00||||183.00|||
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]|183.00||||183.00|||
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]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|183.00||||183.00|||
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|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|183.00||||183.00|||
10020|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L18 MM OD2.7 MM ODSEC5 MM CORTEX SELF TAP SPHERICAL HEAD SMALL HEXAGONAL SOCKET NONSTERILE MODULAR MINI FRAGMENT SET|GEHA [1415]|GEHA - ASA [141503]|183.00||||183.00|||
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]|183.00||||183.00|||
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|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|183.00||||183.00|||
10020|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L18 MM OD2.7 MM ODSEC5 MM CORTEX SELF TAP SPHERICAL HEAD SMALL HEXAGONAL SOCKET NONSTERILE MODULAR MINI FRAGMENT SET|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|183.00||||183.00|||
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 MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|183.00||||183.00|||
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]|183.00||||183.00|||
10020|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L18 MM OD2.7 MM ODSEC5 MM CORTEX SELF TAP SPHERICAL HEAD SMALL HEXAGONAL SOCKET NONSTERILE MODULAR MINI FRAGMENT SET|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|183.00||||183.00|||
10020|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L18 MM OD2.7 MM ODSEC5 MM CORTEX SELF TAP SPHERICAL HEAD SMALL HEXAGONAL SOCKET NONSTERILE MODULAR MINI FRAGMENT SET|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|183.00||||183.00|||
10020|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L18 MM OD2.7 MM ODSEC5 MM CORTEX SELF TAP SPHERICAL HEAD SMALL HEXAGONAL SOCKET NONSTERILE MODULAR MINI FRAGMENT SET|UMR [2035]|UMR OPTIONS [203501]|183.00||||183.00|||
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|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|183.00||||183.00|||
100203|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 52MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|1240.00||||1240.00|1116|1116|260.4
100203|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 52MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|1240.00||||1240.00|1116|1116|260.4
100203|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 52MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|TRUSTMARK [2030]|STARMARK [203000]|1240.00||||1240.00|1116|1116|260.4
100203|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 52MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|1240.00||||1240.00|1116|1116|260.4
100203|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 52MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|1240.00||||1240.00|1116|1116|260.4
100203|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 52MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|GROUP PENSION ADMIN [1450]|GPA [145000]|1240.00||||1240.00|868|1116|260.4
100203|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 52MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|FIRST HEALTH [1375]|QUALCHOICE [137513]|1240.00||||1240.00|1116|1116|260.4
100203|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 52MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|1240.00||||1240.00|1116|1116|260.4
100203|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 52MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|1240.00||||1240.00|806|1116|260.4
100203|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 52MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|1240.00||||1240.00|806|1116|260.4
100203|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 52MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|1240.00||||1240.00|1116|1116|260.4
100203|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 52MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|MULTIPLAN [1680]|IHC HS [168011]|1240.00||||1240.00|1116|1116|260.4
100203|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 52MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|1240.00||||1240.00|1116|1116|260.4
100203|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 52MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|AETNA [1015]|AMERICAN CONTINENTAL [101507]|1240.00||||1240.00|868|1116|260.4
100203|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 52MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|AETNA [1015]|COVENTRY HEALTHCARE [101502]|1240.00||||1240.00|1116|1116|260.4
100203|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 52MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|1240.00||||1240.00|717.96|1116|260.4
100203|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 52MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|1240.00||||1240.00|610.08|1116|260.4
100203|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 52MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|1240.00||||1240.00|502.2|1116|260.4
100203|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 52MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|1240.00||||1240.00|533.2|1116|260.4
100203|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 52MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|1240.00||||1240.00|1116|1116|260.4
100203|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 52MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|1240.00||||1240.00|1116|1116|260.4
100203|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 52MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|1240.00||||1240.00|806|1116|260.4
100203|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 52MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|CORESOURCE [1315]|CORESOURCE [131500]|1240.00||||1240.00|1116|1116|260.4
100203|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 52MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|1240.00||||1240.00|1116|1116|260.4
100203|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 52MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|1240.00||||1240.00|1116|1116|260.4
100203|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 52MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|<Self-pay>|<Self-pay>|1240.00||||1240.00|372|1116|260.4
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]|1240.00||||1240.00|395.56|1116|260.4
100203|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 52MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|FIRST HEALTH [1375]|BENVEO/UCS [137512]|1240.00||||1240.00|1054|1116|260.4
100203|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 52MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|HEALTHNET [1495]|HEALTHNET [149500]|1240.00||||1240.00|1116|1116|260.4
100203|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 52MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|1240.00||||1240.00|1116|1116|260.4
100203|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 52MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|1240.00||||1240.00|1116|1116|260.4
100203|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 52MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|CIGNA [1260]|CIGNA - GREAT WEST [126009]|1240.00||||1240.00|868|1116|260.4
100203|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 52MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|1240.00||||1240.00|1116|1116|260.4
100203|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 52MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|FMH BENEFIT SERVICES [1390]|FMH [139000]|1240.00||||1240.00|1116|1116|260.4
100203|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 52MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|1240.00||||1240.00|409.2|1116|260.4
100203|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 52MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|SAMBA HEALTH [2305]|SAMBA HEALTH [230500]|1240.00||||1240.00|868|1116|260.4
100203|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 52MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|1240.00||||1240.00|260.4|1116|260.4
100203|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 52MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|1240.00||||1240.00|620|1116|260.4
100203|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 52MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|1240.00||||1240.00|1116|1116|260.4
100203|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 52MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|1240.00||||1240.00|620|1116|260.4
100203|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 52MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|1240.00||||1240.00|954.8|1116|260.4
100203|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 52MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|1240.00||||1240.00|533.2|1116|260.4
100203|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 52MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|1240.00||||1240.00|||
100203|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 52MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|UMR [2035]|UMR OPTIONS [203501]|1240.00||||1240.00|||
100203|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 52MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|1240.00||||1240.00|||
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]|1240.00||||1240.00|||
100203|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 52MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|1240.00||||1240.00|||
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]|1240.00||||1240.00|||
100203|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 52MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|GEHA [1415]|GEHA - ASA [141503]|1240.00||||1240.00|||
100203|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 52MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|1240.00||||1240.00|||
100203|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 52MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|MULTIPLAN [1680]|HMA [168003]|1240.00||||1240.00|||
100203|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 52MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|AETNA [1015]|AETNA ACO WILCO [101532]|1240.00||||1240.00|||
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]|1240.00||||1240.00|||
100203|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 52MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|1240.00||||1240.00|||
100203|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 52MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|1240.00||||1240.00|||
100203|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 52MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|1240.00||||1240.00|||
100203|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 52MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|1240.00||||1240.00|||
100203|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 52MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|1240.00||||1240.00|||
100203|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 52MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|CHAMPVA [1240]|CHAMP VA [124000]|1240.00||||1240.00|||
100203|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 52MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|1240.00||||1240.00|||
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]|1240.00||||1240.00|||
100203|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 52MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|1240.00||||1240.00|||
100203|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 52MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|1240.00||||1240.00|||
100203|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 52MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|1240.00||||1240.00|||
100203|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 52MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|1240.00||||1240.00|||
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]|1240.00||||1240.00|||
100203|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 52MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|1240.00||||1240.00|||
100203|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 52MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|1240.00||||1240.00|||
100203|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 52MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|1240.00||||1240.00|||
100203|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 52MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|1240.00||||1240.00|||
100203|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 52MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|1240.00||||1240.00|||
100207|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 53MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|1240.00||||1240.00|533.2|1116|260.4
100207|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 53MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|1240.00||||1240.00|620|1116|260.4
100207|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 53MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|1240.00||||1240.00|620|1116|260.4
100207|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 53MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|1240.00||||1240.00|260.4|1116|260.4
100207|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 53MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|1240.00||||1240.00|409.2|1116|260.4
100207|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 53MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|FMH BENEFIT SERVICES [1390]|FMH [139000]|1240.00||||1240.00|1116|1116|260.4
100207|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 53MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|1240.00||||1240.00|1116|1116|260.4
100207|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 53MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|1240.00||||1240.00|1116|1116|260.4
100207|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 53MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|1240.00||||1240.00|1116|1116|260.4
100207|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 53MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|1240.00||||1240.00|395.56|1116|260.4
100207|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 53MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|1240.00||||1240.00|1116|1116|260.4
100207|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 53MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|CORESOURCE [1315]|CORESOURCE [131500]|1240.00||||1240.00|1116|1116|260.4
100207|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 53MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|1240.00||||1240.00|1116|1116|260.4
100207|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 53MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|1240.00||||1240.00|1116|1116|260.4
100207|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 53MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|1240.00||||1240.00|806|1116|260.4
100207|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 53MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|1240.00||||1240.00|717.96|1116|260.4
100207|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 53MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|1240.00||||1240.00|533.2|1116|260.4
100207|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 53MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|1240.00||||1240.00|502.2|1116|260.4
100207|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 53MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|1240.00||||1240.00|610.08|1116|260.4
100207|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 53MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|1240.00||||1240.00|1116|1116|260.4
100207|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 53MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|AETNA [1015]|AMERICAN CONTINENTAL [101507]|1240.00||||1240.00|868|1116|260.4
100207|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 53MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|AETNA [1015]|COVENTRY HEALTHCARE [101502]|1240.00||||1240.00|1116|1116|260.4
100207|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 53MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|1240.00||||1240.00|1116|1116|260.4
100207|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 53MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|MULTIPLAN [1680]|IHC HS [168011]|1240.00||||1240.00|1116|1116|260.4
100207|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 53MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|HEALTHNET [1495]|HEALTHNET [149500]|1240.00||||1240.00|1116|1116|260.4
100207|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 53MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|CIGNA [1260]|CIGNA - GREAT WEST [126009]|1240.00||||1240.00|868|1116|260.4
100207|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 53MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|1240.00||||1240.00|1116|1116|260.4
100207|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 53MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|1240.00||||1240.00|806|1116|260.4
100207|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 53MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|1240.00||||1240.00|806|1116|260.4
100207|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 53MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|1240.00||||1240.00|1116|1116|260.4
100207|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 53MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|<Self-pay>|<Self-pay>|1240.00||||1240.00|372|1116|260.4
100207|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 53MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|1240.00||||1240.00|1116|1116|260.4
100207|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 53MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|1240.00||||1240.00|954.8|1116|260.4
100207|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 53MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|FIRST HEALTH [1375]|QUALCHOICE [137513]|1240.00||||1240.00|1116|1116|260.4
100207|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 53MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|FIRST HEALTH [1375]|BENVEO/UCS [137512]|1240.00||||1240.00|1054|1116|260.4
100207|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 53MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|GROUP PENSION ADMIN [1450]|GPA [145000]|1240.00||||1240.00|868|1116|260.4
100207|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 53MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|1240.00||||1240.00|1116|1116|260.4
100207|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 53MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|1240.00||||1240.00|1116|1116|260.4
100207|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 53MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|TRUSTMARK [2030]|STARMARK [203000]|1240.00||||1240.00|1116|1116|260.4
100207|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 53MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|1240.00||||1240.00|1116|1116|260.4
100207|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 53MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|1240.00||||1240.00|1116|1116|260.4
100207|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 53MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|SAMBA HEALTH [2305]|SAMBA HEALTH [230500]|1240.00||||1240.00|868|1116|260.4
100207|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 53MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|1240.00||||1240.00|||
100207|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 53MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|1240.00||||1240.00|||
100207|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 53MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|1240.00||||1240.00|||
100207|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 53MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|1240.00||||1240.00|||
100207|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 53MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|1240.00||||1240.00|||
100207|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 53MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|1240.00||||1240.00|||
100207|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 53MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|1240.00||||1240.00|||
100207|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 53MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|1240.00||||1240.00|||
100207|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 53MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|1240.00||||1240.00|||
100207|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 53MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|1240.00||||1240.00|||
100207|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 53MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|1240.00||||1240.00|||
100207|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 53MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|CHAMPVA [1240]|CHAMP VA [124000]|1240.00||||1240.00|||
100207|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 53MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|1240.00||||1240.00|||
100207|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 53MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|1240.00||||1240.00|||
100207|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 53MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|1240.00||||1240.00|||
100207|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 53MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|1240.00||||1240.00|||
100207|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 53MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|1240.00||||1240.00|||
100207|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 53MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|AETNA [1015]|AETNA ACO WILCO [101532]|1240.00||||1240.00|||
100207|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 53MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|1240.00||||1240.00|||
100207|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 53MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|MULTIPLAN [1680]|HMA [168003]|1240.00||||1240.00|||
100207|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 53MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|1240.00||||1240.00|||
100207|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 53MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|GEHA [1415]|GEHA - ASA [141503]|1240.00||||1240.00|||
100207|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 53MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|UNITED HEALTHCARE [2060]|UHC MEDICA CHOICE [206030]|1240.00||||1240.00|||
100207|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 53MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|1240.00||||1240.00|||
100207|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 53MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|1240.00||||1240.00|||
100207|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 53MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|1240.00||||1240.00|||
100207|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 53MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|1240.00||||1240.00|||
100207|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 53MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|UMR [2035]|UMR OPTIONS [203501]|1240.00||||1240.00|||
100207|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 53MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|1240.00||||1240.00|||
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|SAMBA HEALTH [2305]|SAMBA HEALTH [230500]|183.00||||183.00|128.1|164.7|38.43
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|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|183.00||||183.00|164.7|164.7|38.43
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|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|183.00||||183.00|164.7|164.7|38.43
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|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|183.00||||183.00|164.7|164.7|38.43
10021|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L22 MM OD2.7 MM ODSEC5 MM CORTEX SELF TAP SPHERICAL HEAD SMALL HEXAGONAL SOCKET NONSTERILE MODULAR MINI FRAGMENT SET|TRUSTMARK [2030]|STARMARK [203000]|183.00||||183.00|164.7|164.7|38.43
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|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|183.00||||183.00|164.7|164.7|38.43
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]|QUALCHOICE [137513]|183.00||||183.00|164.7|164.7|38.43
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]|BENVEO/UCS [137512]|183.00||||183.00|155.55|164.7|38.43
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>|183.00||||183.00|54.9|164.7|38.43
10021|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L22 MM OD2.7 MM ODSEC5 MM CORTEX SELF TAP SPHERICAL HEAD SMALL HEXAGONAL SOCKET NONSTERILE MODULAR MINI FRAGMENT SET|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|183.00||||183.00|164.7|164.7|38.43
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|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|183.00||||183.00|118.95|164.7|38.43
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|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|183.00||||183.00|118.95|164.7|38.43
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]|IHC HS [168011]|183.00||||183.00|164.7|164.7|38.43
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]|AMERICAN CONTINENTAL [101507]|183.00||||183.00|128.1|164.7|38.43
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]|COVENTRY HEALTHCARE [101502]|183.00||||183.00|164.7|164.7|38.43
10021|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L22 MM OD2.7 MM ODSEC5 MM CORTEX SELF TAP SPHERICAL HEAD SMALL HEXAGONAL SOCKET NONSTERILE MODULAR MINI FRAGMENT SET|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|183.00||||183.00|105.96|164.7|38.43
10021|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L22 MM OD2.7 MM ODSEC5 MM CORTEX SELF TAP SPHERICAL HEAD SMALL HEXAGONAL SOCKET NONSTERILE MODULAR MINI FRAGMENT SET|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|183.00||||183.00|78.69|164.7|38.43
10021|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L22 MM OD2.7 MM ODSEC5 MM CORTEX SELF TAP SPHERICAL HEAD SMALL HEXAGONAL SOCKET NONSTERILE MODULAR MINI FRAGMENT SET|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|183.00||||183.00|90.04|164.7|38.43
10021|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L22 MM OD2.7 MM ODSEC5 MM CORTEX SELF TAP SPHERICAL HEAD SMALL HEXAGONAL SOCKET NONSTERILE MODULAR MINI FRAGMENT SET|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|183.00||||183.00|74.12|164.7|38.43
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 HEALTH CARE [132000]|183.00||||183.00|164.7|164.7|38.43
10021|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L22 MM OD2.7 MM ODSEC5 MM CORTEX SELF TAP SPHERICAL HEAD SMALL HEXAGONAL SOCKET NONSTERILE MODULAR MINI FRAGMENT SET|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|183.00||||183.00|164.7|164.7|38.43
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|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|183.00||||183.00|164.7|164.7|38.43
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|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|183.00||||183.00|118.95|164.7|38.43
10021|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L22 MM OD2.7 MM ODSEC5 MM CORTEX SELF TAP SPHERICAL HEAD SMALL HEXAGONAL SOCKET NONSTERILE MODULAR MINI FRAGMENT SET|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|183.00||||183.00|164.7|164.7|38.43
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|CORESOURCE [1315]|CORESOURCE [131500]|183.00||||183.00|164.7|164.7|38.43
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|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|183.00||||183.00|164.7|164.7|38.43
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|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|183.00||||183.00|164.7|164.7|38.43
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]|183.00||||183.00|58.38|164.7|38.43
10021|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L22 MM OD2.7 MM ODSEC5 MM CORTEX SELF TAP SPHERICAL HEAD SMALL HEXAGONAL SOCKET NONSTERILE MODULAR MINI FRAGMENT SET|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|183.00||||183.00|164.7|164.7|38.43
10021|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L22 MM OD2.7 MM ODSEC5 MM CORTEX SELF TAP SPHERICAL HEAD SMALL HEXAGONAL SOCKET NONSTERILE MODULAR MINI FRAGMENT SET|HEALTHNET [1495]|HEALTHNET [149500]|183.00||||183.00|164.7|164.7|38.43
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|GROUP PENSION ADMIN [1450]|GPA [145000]|183.00||||183.00|128.1|164.7|38.43
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]|183.00||||183.00|164.7|164.7|38.43
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 - GREAT WEST [126009]|183.00||||183.00|128.1|164.7|38.43
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 MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|183.00||||183.00|164.7|164.7|38.43
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|FMH BENEFIT SERVICES [1390]|FMH [139000]|183.00||||183.00|164.7|164.7|38.43
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]|183.00||||183.00|60.39|164.7|38.43
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|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|183.00||||183.00|38.43|164.7|38.43
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|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|183.00||||183.00|91.5|164.7|38.43
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 TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|183.00||||183.00|164.7|164.7|38.43
10021|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L22 MM OD2.7 MM ODSEC5 MM CORTEX SELF TAP SPHERICAL HEAD SMALL HEXAGONAL SOCKET NONSTERILE MODULAR MINI FRAGMENT SET|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|183.00||||183.00|91.5|164.7|38.43
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|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|183.00||||183.00|78.69|164.7|38.43
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|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|183.00||||183.00|140.91|164.7|38.43
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|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|183.00||||183.00|||
10021|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L22 MM OD2.7 MM ODSEC5 MM CORTEX SELF TAP SPHERICAL HEAD SMALL HEXAGONAL SOCKET NONSTERILE MODULAR MINI FRAGMENT SET|UMR [2035]|UMR OPTIONS [203501]|183.00||||183.00|||
10021|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L22 MM OD2.7 MM ODSEC5 MM CORTEX SELF TAP SPHERICAL HEAD SMALL HEXAGONAL SOCKET NONSTERILE MODULAR MINI FRAGMENT SET|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|183.00||||183.00|||
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]|183.00||||183.00|||
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]|183.00||||183.00|||
10021|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L22 MM OD2.7 MM ODSEC5 MM CORTEX SELF TAP SPHERICAL HEAD SMALL HEXAGONAL SOCKET NONSTERILE MODULAR MINI FRAGMENT SET|GEHA [1415]|GEHA - ASA [141503]|183.00||||183.00|||
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|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|183.00||||183.00|||
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]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|183.00||||183.00|||
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]|183.00||||183.00|||
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]|183.00||||183.00|||
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]|183.00||||183.00|||
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|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|183.00||||183.00|||
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 MEDICARE SUPPLEMENT [101514]|183.00||||183.00|||
10021|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L22 MM OD2.7 MM ODSEC5 MM CORTEX SELF TAP SPHERICAL HEAD SMALL HEXAGONAL SOCKET NONSTERILE MODULAR MINI FRAGMENT SET|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|183.00||||183.00|||
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|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|183.00||||183.00|||
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]|183.00||||183.00|||
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|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|183.00||||183.00|||
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]|183.00||||183.00|||
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|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|183.00||||183.00|||
10021|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L22 MM OD2.7 MM ODSEC5 MM CORTEX SELF TAP SPHERICAL HEAD SMALL HEXAGONAL SOCKET NONSTERILE MODULAR MINI FRAGMENT SET|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|183.00||||183.00|||
10021|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L22 MM OD2.7 MM ODSEC5 MM CORTEX SELF TAP SPHERICAL HEAD SMALL HEXAGONAL SOCKET NONSTERILE MODULAR MINI FRAGMENT SET|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|183.00||||183.00|||
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|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|183.00||||183.00|||
10021|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L22 MM OD2.7 MM ODSEC5 MM CORTEX SELF TAP SPHERICAL HEAD SMALL HEXAGONAL SOCKET NONSTERILE MODULAR MINI FRAGMENT SET|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|183.00||||183.00|||
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]|183.00||||183.00|||
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 IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|183.00||||183.00|||
10021|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L22 MM OD2.7 MM ODSEC5 MM CORTEX SELF TAP SPHERICAL HEAD SMALL HEXAGONAL SOCKET NONSTERILE MODULAR MINI FRAGMENT SET|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|183.00||||183.00|||
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 MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|183.00||||183.00|||
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 MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|183.00||||183.00|||
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|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|183.00||||183.00|||
100211|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 54MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|1240.00||||1240.00|533.2|1116|260.4
100211|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 54MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|1240.00||||1240.00|954.8|1116|260.4
100211|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 54MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|1240.00||||1240.00|620|1116|260.4
100211|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 54MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|1240.00||||1240.00|1116|1116|260.4
100211|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 54MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|1240.00||||1240.00|620|1116|260.4
100211|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 54MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|1240.00||||1240.00|260.4|1116|260.4
100211|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 54MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|1240.00||||1240.00|409.2|1116|260.4
100211|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 54MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|1240.00||||1240.00|1116|1116|260.4
100211|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 54MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|CIGNA [1260]|CIGNA - GREAT WEST [126009]|1240.00||||1240.00|868|1116|260.4
100211|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 54MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|1240.00||||1240.00|1116|1116|260.4
100211|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 54MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|HEALTHNET [1495]|HEALTHNET [149500]|1240.00||||1240.00|1116|1116|260.4
100211|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 54MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|1240.00||||1240.00|1116|1116|260.4
100211|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 54MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|1240.00||||1240.00|1116|1116|260.4
100211|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 54MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|CORESOURCE [1315]|CORESOURCE [131500]|1240.00||||1240.00|1116|1116|260.4
100211|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 54MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|1240.00||||1240.00|806|1116|260.4
100211|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 54MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|1240.00||||1240.00|1116|1116|260.4
100211|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 54MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|1240.00||||1240.00|1116|1116|260.4
100211|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 54MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|1240.00||||1240.00|610.08|1116|260.4
100211|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 54MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|1240.00||||1240.00|533.2|1116|260.4
100211|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 54MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|1240.00||||1240.00|502.2|1116|260.4
100211|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 54MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|1240.00||||1240.00|717.96|1116|260.4
100211|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 54MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|1240.00||||1240.00|1116|1116|260.4
100211|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 54MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|AETNA [1015]|COVENTRY HEALTHCARE [101502]|1240.00||||1240.00|1116|1116|260.4
100211|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 54MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|AETNA [1015]|AMERICAN CONTINENTAL [101507]|1240.00||||1240.00|868|1116|260.4
100211|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 54MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|1240.00||||1240.00|395.56|1116|260.4
100211|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 54MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|1240.00||||1240.00|1116|1116|260.4
100211|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 54MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|MULTIPLAN [1680]|IHC HS [168011]|1240.00||||1240.00|1116|1116|260.4
100211|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 54MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|1240.00||||1240.00|1116|1116|260.4
100211|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 54MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|FMH BENEFIT SERVICES [1390]|FMH [139000]|1240.00||||1240.00|1116|1116|260.4
100211|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 54MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|1240.00||||1240.00|806|1116|260.4
100211|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 54MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|1240.00||||1240.00|806|1116|260.4
100211|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 54MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|1240.00||||1240.00|1116|1116|260.4
100211|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 54MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|<Self-pay>|<Self-pay>|1240.00||||1240.00|372|1116|260.4
100211|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 54MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|FIRST HEALTH [1375]|BENVEO/UCS [137512]|1240.00||||1240.00|1054|1116|260.4
100211|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 54MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|FIRST HEALTH [1375]|QUALCHOICE [137513]|1240.00||||1240.00|1116|1116|260.4
100211|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 54MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|GROUP PENSION ADMIN [1450]|GPA [145000]|1240.00||||1240.00|868|1116|260.4
100211|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 54MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|1240.00||||1240.00|1116|1116|260.4
100211|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 54MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|TRUSTMARK [2030]|STARMARK [203000]|1240.00||||1240.00|1116|1116|260.4
100211|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 54MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|1240.00||||1240.00|1116|1116|260.4
100211|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 54MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|1240.00||||1240.00|1116|1116|260.4
100211|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 54MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|1240.00||||1240.00|1116|1116|260.4
100211|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 54MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|SAMBA HEALTH [2305]|SAMBA HEALTH [230500]|1240.00||||1240.00|868|1116|260.4
100211|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 54MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|1240.00||||1240.00|||
100211|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 54MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|1240.00||||1240.00|||
100211|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 54MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|1240.00||||1240.00|||
100211|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 54MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|1240.00||||1240.00|||
100211|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 54MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|1240.00||||1240.00|||
100211|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 54MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|1240.00||||1240.00|||
100211|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 54MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|1240.00||||1240.00|||
100211|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 54MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|1240.00||||1240.00|||
100211|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 54MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|1240.00||||1240.00|||
100211|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 54MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|CHAMPVA [1240]|CHAMP VA [124000]|1240.00||||1240.00|||
100211|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 54MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|1240.00||||1240.00|||
100211|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 54MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|1240.00||||1240.00|||
100211|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 54MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|1240.00||||1240.00|||
100211|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 54MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|1240.00||||1240.00|||
100211|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 54MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|AETNA [1015]|AETNA ACO WILCO [101532]|1240.00||||1240.00|||
100211|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 54MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|1240.00||||1240.00|||
100211|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 54MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|1240.00||||1240.00|||
100211|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 54MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|MULTIPLAN [1680]|HMA [168003]|1240.00||||1240.00|||
100211|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 54MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|1240.00||||1240.00|||
100211|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 54MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|GEHA [1415]|GEHA - ASA [141503]|1240.00||||1240.00|||
100211|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 54MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|UNITED HEALTHCARE [2060]|UHC MEDICA CHOICE [206030]|1240.00||||1240.00|||
100211|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 54MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|1240.00||||1240.00|||
100211|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 54MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|1240.00||||1240.00|||
100211|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 54MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|1240.00||||1240.00|||
100211|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 54MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|1240.00||||1240.00|||
100211|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 54MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|1240.00||||1240.00|||
100211|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 54MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|1240.00||||1240.00|||
100211|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 54MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|UMR [2035]|UMR OPTIONS [203501]|1240.00||||1240.00|||
100211|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 54MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|1240.00||||1240.00|||
100215|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 55MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|SAMBA HEALTH [2305]|SAMBA HEALTH [230500]|1240.00||||1240.00|868|1116|260.4
100215|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 55MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|1240.00||||1240.00|1116|1116|260.4
100215|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 55MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|1240.00||||1240.00|1116|1116|260.4
100215|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 55MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|TRUSTMARK [2030]|STARMARK [203000]|1240.00||||1240.00|1116|1116|260.4
100215|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 55MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|1240.00||||1240.00|1116|1116|260.4
100215|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 55MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|GROUP PENSION ADMIN [1450]|GPA [145000]|1240.00||||1240.00|868|1116|260.4
100215|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 55MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|FIRST HEALTH [1375]|BENVEO/UCS [137512]|1240.00||||1240.00|1054|1116|260.4
100215|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 55MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|<Self-pay>|<Self-pay>|1240.00||||1240.00|372|1116|260.4
100215|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 55MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|1240.00||||1240.00|1116|1116|260.4
100215|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 55MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|1240.00||||1240.00|806|1116|260.4
100215|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 55MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|1240.00||||1240.00|1116|1116|260.4
100215|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 55MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|MULTIPLAN [1680]|IHC HS [168011]|1240.00||||1240.00|1116|1116|260.4
100215|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 55MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|AETNA [1015]|AMERICAN CONTINENTAL [101507]|1240.00||||1240.00|868|1116|260.4
100215|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 55MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|AETNA [1015]|COVENTRY HEALTHCARE [101502]|1240.00||||1240.00|1116|1116|260.4
100215|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 55MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|1240.00||||1240.00|1116|1116|260.4
100215|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 55MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|1240.00||||1240.00|717.96|1116|260.4
100215|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 55MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|1240.00||||1240.00|610.08|1116|260.4
100215|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 55MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|1240.00||||1240.00|533.2|1116|260.4
100215|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 55MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|1240.00||||1240.00|502.2|1116|260.4
100215|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 55MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|1240.00||||1240.00|1116|1116|260.4
100215|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 55MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|1240.00||||1240.00|1116|1116|260.4
100215|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 55MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|1240.00||||1240.00|806|1116|260.4
100215|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 55MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|CORESOURCE [1315]|CORESOURCE [131500]|1240.00||||1240.00|1116|1116|260.4
100215|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 55MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|1240.00||||1240.00|806|1116|260.4
100215|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 55MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|1240.00||||1240.00|1116|1116|260.4
100215|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 55MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|1240.00||||1240.00|1116|1116|260.4
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]|1240.00||||1240.00|395.56|1116|260.4
100215|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 55MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|FIRST HEALTH [1375]|QUALCHOICE [137513]|1240.00||||1240.00|1116|1116|260.4
100215|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 55MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|HEALTHNET [1495]|HEALTHNET [149500]|1240.00||||1240.00|1116|1116|260.4
100215|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 55MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|1240.00||||1240.00|1116|1116|260.4
100215|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 55MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|1240.00||||1240.00|1116|1116|260.4
100215|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 55MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|CIGNA [1260]|CIGNA - GREAT WEST [126009]|1240.00||||1240.00|868|1116|260.4
100215|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 55MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|1240.00||||1240.00|1116|1116|260.4
100215|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 55MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|1240.00||||1240.00|1116|1116|260.4
100215|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 55MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|FMH BENEFIT SERVICES [1390]|FMH [139000]|1240.00||||1240.00|1116|1116|260.4
100215|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 55MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|1240.00||||1240.00|409.2|1116|260.4
100215|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 55MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|1240.00||||1240.00|260.4|1116|260.4
100215|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 55MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|1240.00||||1240.00|620|1116|260.4
100215|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 55MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|1240.00||||1240.00|1116|1116|260.4
100215|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 55MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|1240.00||||1240.00|620|1116|260.4
100215|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 55MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|1240.00||||1240.00|954.8|1116|260.4
100215|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 55MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|1240.00||||1240.00|533.2|1116|260.4
100215|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 55MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|1240.00||||1240.00|||
100215|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 55MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|UMR [2035]|UMR OPTIONS [203501]|1240.00||||1240.00|||
100215|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 55MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|1240.00||||1240.00|||
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]|1240.00||||1240.00|||
100215|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 55MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|1240.00||||1240.00|||
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]|1240.00||||1240.00|||
100215|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 55MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|GEHA [1415]|GEHA - ASA [141503]|1240.00||||1240.00|||
100215|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 55MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|1240.00||||1240.00|||
100215|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 55MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|MULTIPLAN [1680]|HMA [168003]|1240.00||||1240.00|||
100215|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 55MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|1240.00||||1240.00|||
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]|1240.00||||1240.00|||
100215|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 55MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|AETNA [1015]|AETNA ACO WILCO [101532]|1240.00||||1240.00|||
100215|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 55MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|1240.00||||1240.00|||
100215|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 55MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|1240.00||||1240.00|||
100215|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 55MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|1240.00||||1240.00|||
100215|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 55MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|1240.00||||1240.00|||
100215|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 55MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|CHAMPVA [1240]|CHAMP VA [124000]|1240.00||||1240.00|||
100215|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 55MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|1240.00||||1240.00|||
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]|1240.00||||1240.00|||
100215|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 55MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|1240.00||||1240.00|||
100215|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 55MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|1240.00||||1240.00|||
100215|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 55MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|1240.00||||1240.00|||
100215|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 55MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|1240.00||||1240.00|||
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]|1240.00||||1240.00|||
100215|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 55MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|1240.00||||1240.00|||
100215|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 55MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|1240.00||||1240.00|||
100215|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 55MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|1240.00||||1240.00|||
100215|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 55MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|1240.00||||1240.00|||
100215|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 55MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|1240.00||||1240.00|||
100219|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 56MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|1240.00||||1240.00|533.2|1116|260.4
100219|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 56MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|1240.00||||1240.00|620|1116|260.4
100219|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 56MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|1240.00||||1240.00|1116|1116|260.4
100219|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 56MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|1240.00||||1240.00|620|1116|260.4
100219|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 56MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|1240.00||||1240.00|260.4|1116|260.4
100219|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 56MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|1240.00||||1240.00|409.2|1116|260.4
100219|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 56MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|FMH BENEFIT SERVICES [1390]|FMH [139000]|1240.00||||1240.00|1116|1116|260.4
100219|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 56MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|1240.00||||1240.00|1116|1116|260.4
100219|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 56MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|1240.00||||1240.00|1116|1116|260.4
100219|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 56MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|1240.00||||1240.00|1116|1116|260.4
100219|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 56MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|HEALTHNET [1495]|HEALTHNET [149500]|1240.00||||1240.00|1116|1116|260.4
100219|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 56MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|1240.00||||1240.00|395.56|1116|260.4
100219|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 56MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|1240.00||||1240.00|1116|1116|260.4
100219|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 56MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|1240.00||||1240.00|1116|1116|260.4
100219|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 56MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|1240.00||||1240.00|1116|1116|260.4
100219|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 56MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|1240.00||||1240.00|1116|1116|260.4
100219|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 56MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|1240.00||||1240.00|806|1116|260.4
100219|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 56MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|1240.00||||1240.00|502.2|1116|260.4
100219|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 56MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|CORESOURCE [1315]|CORESOURCE [131500]|1240.00||||1240.00|1116|1116|260.4
100219|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 56MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|1240.00||||1240.00|717.96|1116|260.4
100219|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 56MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|1240.00||||1240.00|533.2|1116|260.4
100219|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 56MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|1240.00||||1240.00|610.08|1116|260.4
100219|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 56MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|1240.00||||1240.00|1116|1116|260.4
100219|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 56MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|AETNA [1015]|COVENTRY HEALTHCARE [101502]|1240.00||||1240.00|1116|1116|260.4
100219|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 56MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|AETNA [1015]|AMERICAN CONTINENTAL [101507]|1240.00||||1240.00|868|1116|260.4
100219|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 56MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|MULTIPLAN [1680]|IHC HS [168011]|1240.00||||1240.00|1116|1116|260.4
100219|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 56MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|CIGNA [1260]|CIGNA - GREAT WEST [126009]|1240.00||||1240.00|868|1116|260.4
100219|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 56MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|1240.00||||1240.00|1116|1116|260.4
100219|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 56MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|1240.00||||1240.00|806|1116|260.4
100219|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 56MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|1240.00||||1240.00|806|1116|260.4
100219|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 56MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|1240.00||||1240.00|1116|1116|260.4
100219|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 56MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|<Self-pay>|<Self-pay>|1240.00||||1240.00|372|1116|260.4
100219|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 56MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|FIRST HEALTH [1375]|QUALCHOICE [137513]|1240.00||||1240.00|1116|1116|260.4
100219|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 56MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|FIRST HEALTH [1375]|BENVEO/UCS [137512]|1240.00||||1240.00|1054|1116|260.4
100219|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 56MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|1240.00||||1240.00|954.8|1116|260.4
100219|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 56MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|GROUP PENSION ADMIN [1450]|GPA [145000]|1240.00||||1240.00|868|1116|260.4
100219|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 56MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|1240.00||||1240.00|1116|1116|260.4
100219|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 56MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|TRUSTMARK [2030]|STARMARK [203000]|1240.00||||1240.00|1116|1116|260.4
100219|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 56MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|1240.00||||1240.00|1116|1116|260.4
100219|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 56MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|1240.00||||1240.00|1116|1116|260.4
100219|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 56MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|1240.00||||1240.00|1116|1116|260.4
100219|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 56MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|SAMBA HEALTH [2305]|SAMBA HEALTH [230500]|1240.00||||1240.00|868|1116|260.4
100219|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 56MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|1240.00||||1240.00|||
100219|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 56MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|1240.00||||1240.00|||
100219|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 56MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|1240.00||||1240.00|||
100219|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 56MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|1240.00||||1240.00|||
100219|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 56MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|1240.00||||1240.00|||
100219|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 56MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|1240.00||||1240.00|||
100219|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 56MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|1240.00||||1240.00|||
100219|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 56MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|1240.00||||1240.00|||
100219|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 56MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|1240.00||||1240.00|||
100219|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 56MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|CHAMPVA [1240]|CHAMP VA [124000]|1240.00||||1240.00|||
100219|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 56MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|1240.00||||1240.00|||
100219|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 56MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|1240.00||||1240.00|||
100219|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 56MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|1240.00||||1240.00|||
100219|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 56MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|1240.00||||1240.00|||
100219|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 56MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|AETNA [1015]|AETNA ACO WILCO [101532]|1240.00||||1240.00|||
100219|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 56MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|1240.00||||1240.00|||
100219|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 56MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|1240.00||||1240.00|||
100219|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 56MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|MULTIPLAN [1680]|HMA [168003]|1240.00||||1240.00|||
100219|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 56MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|1240.00||||1240.00|||
100219|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 56MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|1240.00||||1240.00|||
100219|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 56MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|1240.00||||1240.00|||
100219|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 56MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|GEHA [1415]|GEHA - ASA [141503]|1240.00||||1240.00|||
100219|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 56MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|UNITED HEALTHCARE [2060]|UHC MEDICA CHOICE [206030]|1240.00||||1240.00|||
100219|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 56MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|1240.00||||1240.00|||
100219|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 56MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|1240.00||||1240.00|||
100219|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 56MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|1240.00||||1240.00|||
100219|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 56MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|1240.00||||1240.00|||
100219|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 56MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|UMR [2035]|UMR OPTIONS [203501]|1240.00||||1240.00|||
100219|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 56MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|1240.00||||1240.00|||
100223|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 58MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|SAMBA HEALTH [2305]|SAMBA HEALTH [230500]|1240.00||||1240.00|868|1116|260.4
100223|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 58MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|1240.00||||1240.00|1116|1116|260.4
100223|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 58MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|1240.00||||1240.00|1116|1116|260.4
100223|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 58MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|1240.00||||1240.00|1116|1116|260.4
100223|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 58MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|FIRST HEALTH [1375]|QUALCHOICE [137513]|1240.00||||1240.00|1116|1116|260.4
100223|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 58MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|FIRST HEALTH [1375]|BENVEO/UCS [137512]|1240.00||||1240.00|1054|1116|260.4
100223|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 58MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|<Self-pay>|<Self-pay>|1240.00||||1240.00|372|1116|260.4
100223|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 58MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|1240.00||||1240.00|806|1116|260.4
100223|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 58MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|1240.00||||1240.00|806|1116|260.4
100223|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 58MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|MULTIPLAN [1680]|IHC HS [168011]|1240.00||||1240.00|1116|1116|260.4
100223|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 58MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|AETNA [1015]|AMERICAN CONTINENTAL [101507]|1240.00||||1240.00|868|1116|260.4
100223|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 58MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|1240.00||||1240.00|1116|1116|260.4
100223|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 58MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|1240.00||||1240.00|610.08|1116|260.4
100223|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 58MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|1240.00||||1240.00|533.2|1116|260.4
100223|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 58MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|1240.00||||1240.00|717.96|1116|260.4
100223|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 58MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|1240.00||||1240.00|502.2|1116|260.4
100223|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 58MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|1240.00||||1240.00|1116|1116|260.4
100223|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 58MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|AETNA [1015]|COVENTRY HEALTHCARE [101502]|1240.00||||1240.00|1116|1116|260.4
100223|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 58MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|1240.00||||1240.00|1116|1116|260.4
100223|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 58MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|1240.00||||1240.00|806|1116|260.4
100223|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 58MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|1240.00||||1240.00|1116|1116|260.4
100223|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 58MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|CORESOURCE [1315]|CORESOURCE [131500]|1240.00||||1240.00|1116|1116|260.4
100223|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 58MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|1240.00||||1240.00|1116|1116|260.4
100223|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 58MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|1240.00||||1240.00|1116|1116|260.4
100223|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 58MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|1240.00||||1240.00|1116|1116|260.4
100223|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 58MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|1240.00||||1240.00|395.56|1116|260.4
100223|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 58MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|GROUP PENSION ADMIN [1450]|GPA [145000]|1240.00||||1240.00|868|1116|260.4
100223|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 58MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|HEALTHNET [1495]|HEALTHNET [149500]|1240.00||||1240.00|1116|1116|260.4
100223|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 58MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|1240.00||||1240.00|1116|1116|260.4
100223|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 58MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|TRUSTMARK [2030]|STARMARK [203000]|1240.00||||1240.00|1116|1116|260.4
100223|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 58MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|1240.00||||1240.00|1116|1116|260.4
100223|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 58MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|CIGNA [1260]|CIGNA - GREAT WEST [126009]|1240.00||||1240.00|868|1116|260.4
100223|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 58MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|1240.00||||1240.00|1116|1116|260.4
100223|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 58MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|FMH BENEFIT SERVICES [1390]|FMH [139000]|1240.00||||1240.00|1116|1116|260.4
100223|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 58MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|1240.00||||1240.00|1116|1116|260.4
100223|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 58MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|1240.00||||1240.00|409.2|1116|260.4
100223|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 58MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|1240.00||||1240.00|260.4|1116|260.4
100223|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 58MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|1240.00||||1240.00|620|1116|260.4
100223|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 58MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|1240.00||||1240.00|1116|1116|260.4
100223|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 58MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|1240.00||||1240.00|620|1116|260.4
100223|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 58MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|1240.00||||1240.00|954.8|1116|260.4
100223|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 58MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|1240.00||||1240.00|533.2|1116|260.4
100223|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 58MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|1240.00||||1240.00|||
100223|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 58MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|UMR [2035]|UMR OPTIONS [203501]|1240.00||||1240.00|||
100223|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 58MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|1240.00||||1240.00|||
100223|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 58MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|1240.00||||1240.00|||
100223|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 58MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|1240.00||||1240.00|||
100223|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 58MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|1240.00||||1240.00|||
100223|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 58MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|UNITED HEALTHCARE [2060]|UHC MEDICA CHOICE [206030]|1240.00||||1240.00|||
100223|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 58MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|GEHA [1415]|GEHA - ASA [141503]|1240.00||||1240.00|||
100223|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 58MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|1240.00||||1240.00|||
100223|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 58MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|MULTIPLAN [1680]|HMA [168003]|1240.00||||1240.00|||
100223|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 58MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|1240.00||||1240.00|||
100223|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 58MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|1240.00||||1240.00|||
100223|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 58MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|AETNA [1015]|AETNA ACO WILCO [101532]|1240.00||||1240.00|||
100223|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 58MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|1240.00||||1240.00|||
100223|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 58MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|1240.00||||1240.00|||
100223|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 58MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|1240.00||||1240.00|||
100223|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 58MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|1240.00||||1240.00|||
100223|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 58MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|CHAMPVA [1240]|CHAMP VA [124000]|1240.00||||1240.00|||
100223|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 58MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|1240.00||||1240.00|||
100223|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 58MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|1240.00||||1240.00|||
100223|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 58MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|1240.00||||1240.00|||
100223|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 58MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|1240.00||||1240.00|||
100223|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 58MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|1240.00||||1240.00|||
100223|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 58MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|1240.00||||1240.00|||
100223|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 58MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|1240.00||||1240.00|||
100223|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 58MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|1240.00||||1240.00|||
100223|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 58MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|1240.00||||1240.00|||
100223|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 58MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|1240.00||||1240.00|||
100223|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 58MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|1240.00||||1240.00|||
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|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|99.44||||99.44|42.76|89.5|20.88
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|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|99.44||||99.44|76.57|89.5|20.88
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 TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|99.44||||99.44|89.5|89.5|20.88
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|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|99.44||||99.44|20.88|89.5|20.88
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]|99.44||||99.44|32.82|89.5|20.88
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 MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|99.44||||99.44|89.5|89.5|20.88
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 - GREAT WEST [126009]|99.44||||99.44|69.61|89.5|20.88
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|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|99.44||||99.44|89.5|89.5|20.88
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|HEALTHNET [1495]|HEALTHNET [149500]|99.44||||99.44|89.5|89.5|20.88
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]|99.44||||99.44|31.72|89.5|20.88
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|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|99.44||||99.44|89.5|89.5|20.88
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|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|99.44||||99.44|89.5|89.5|20.88
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|CORESOURCE [1315]|CORESOURCE [131500]|99.44||||99.44|89.5|89.5|20.88
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|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|99.44||||99.44|64.64|89.5|20.88
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|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|99.44||||99.44|89.5|89.5|20.88
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|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|99.44||||99.44|89.5|89.5|20.88
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]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|99.44||||99.44|40.27|89.5|20.88
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]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|99.44||||99.44|57.58|89.5|20.88
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]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|99.44||||99.44|48.92|89.5|20.88
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]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|99.44||||99.44|42.76|89.5|20.88
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 HEALTH CARE [132000]|99.44||||99.44|89.5|89.5|20.88
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]|COVENTRY HEALTHCARE [101502]|99.44||||99.44|89.5|89.5|20.88
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]|AMERICAN CONTINENTAL [101507]|99.44||||99.44|69.61|89.5|20.88
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]|99.44||||99.44|89.5|89.5|20.88
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]|IHC HS [168011]|99.44||||99.44|89.5|89.5|20.88
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|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|99.44||||99.44|89.5|89.5|20.88
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|FMH BENEFIT SERVICES [1390]|FMH [139000]|99.44||||99.44|89.5|89.5|20.88
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|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|99.44||||99.44|64.64|89.5|20.88
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|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|99.44||||99.44|64.64|89.5|20.88
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|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|99.44||||99.44|89.5|89.5|20.88
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|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|99.44||||99.44|49.72|89.5|20.88
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>|99.44||||99.44|29.83|89.5|20.88
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]|QUALCHOICE [137513]|99.44||||99.44|89.5|89.5|20.88
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]|BENVEO/UCS [137512]|99.44||||99.44|84.52|89.5|20.88
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|GROUP PENSION ADMIN [1450]|GPA [145000]|99.44||||99.44|69.61|89.5|20.88
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|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|99.44||||99.44|89.5|89.5|20.88
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|TRUSTMARK [2030]|STARMARK [203000]|99.44||||99.44|89.5|89.5|20.88
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|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|99.44||||99.44|89.5|89.5|20.88
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|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|99.44||||99.44|89.5|89.5|20.88
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|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|99.44||||99.44|89.5|89.5|20.88
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|SAMBA HEALTH [2305]|SAMBA HEALTH [230500]|99.44||||99.44|69.61|89.5|20.88
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|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|99.44||||99.44|||
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 MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|99.44||||99.44|||
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 MEDICARE REPLACEMENT [102002]|99.44||||99.44|||
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|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|99.44||||99.44|||
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 IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|99.44||||99.44|||
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]|99.44||||99.44|||
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|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|99.44||||99.44|||
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|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|99.44||||99.44|||
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|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|99.44||||99.44|||
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]|99.44||||99.44|||
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]|99.44||||99.44|||
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|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|99.44||||99.44|||
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|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|99.44||||99.44|||
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]|99.44||||99.44|||
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|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|99.44||||99.44|||
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|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|99.44||||99.44|||
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]|99.44||||99.44|||
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 MEDICARE SUPPLEMENT [101514]|99.44||||99.44|||
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]|99.44||||99.44|||
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]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|99.44||||99.44|||
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|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|99.44||||99.44|||
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 - ASA [141503]|99.44||||99.44|||
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]|99.44||||99.44|||
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|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|99.44||||99.44|||
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 MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|99.44||||99.44|||
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]|99.44||||99.44|||
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|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|99.44||||99.44|||
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 CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|99.44||||99.44|||
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]|UMR OPTIONS [203501]|99.44||||99.44|||
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|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|99.44||||99.44|||
100267|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|INSERT ACETABULAR ENDO II -3 MM TAPER HIP|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|600.00||||600.00|540|540|126
100267|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|INSERT ACETABULAR ENDO II -3 MM TAPER HIP|GROUP PENSION ADMIN [1450]|GPA [145000]|600.00||||600.00|420|540|126
100267|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|INSERT ACETABULAR ENDO II -3 MM TAPER HIP|FIRST HEALTH [1375]|BENVEO/UCS [137512]|600.00||||600.00|510|540|126
100267|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|INSERT ACETABULAR ENDO II -3 MM TAPER HIP|FIRST HEALTH [1375]|QUALCHOICE [137513]|600.00||||600.00|540|540|126
100267|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|INSERT ACETABULAR ENDO II -3 MM TAPER HIP|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|600.00||||600.00|540|540|126
100267|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|INSERT ACETABULAR ENDO II -3 MM TAPER HIP|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|600.00||||600.00|390|540|126
100267|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|INSERT ACETABULAR ENDO II -3 MM TAPER HIP|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|600.00||||600.00|540|540|126
100267|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|INSERT ACETABULAR ENDO II -3 MM TAPER HIP|MULTIPLAN [1680]|IHC HS [168011]|600.00||||600.00|540|540|126
100267|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|INSERT ACETABULAR ENDO II -3 MM TAPER HIP|AETNA [1015]|AMERICAN CONTINENTAL [101507]|600.00||||600.00|420|540|126
100267|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|INSERT ACETABULAR ENDO II -3 MM TAPER HIP|AETNA [1015]|COVENTRY HEALTHCARE [101502]|600.00||||600.00|540|540|126
100267|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|INSERT ACETABULAR ENDO II -3 MM TAPER HIP|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|600.00||||600.00|295.2|540|126
100267|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|INSERT ACETABULAR ENDO II -3 MM TAPER HIP|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|600.00||||600.00|258|540|126
100267|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|INSERT ACETABULAR ENDO II -3 MM TAPER HIP|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|600.00||||600.00|243|540|126
100267|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|INSERT ACETABULAR ENDO II -3 MM TAPER HIP|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|600.00||||600.00|540|540|126
100267|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|INSERT ACETABULAR ENDO II -3 MM TAPER HIP|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|600.00||||600.00|540|540|126
100267|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|INSERT ACETABULAR ENDO II -3 MM TAPER HIP|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|600.00||||600.00|540|540|126
100267|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|INSERT ACETABULAR ENDO II -3 MM TAPER HIP|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|600.00||||600.00|390|540|126
100267|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|INSERT ACETABULAR ENDO II -3 MM TAPER HIP|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|600.00||||600.00|347.4|540|126
100267|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|INSERT ACETABULAR ENDO II -3 MM TAPER HIP|CORESOURCE [1315]|CORESOURCE [131500]|600.00||||600.00|540|540|126
100267|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|INSERT ACETABULAR ENDO II -3 MM TAPER HIP|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|600.00||||600.00|540|540|126
100267|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|INSERT ACETABULAR ENDO II -3 MM TAPER HIP|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|600.00||||600.00|540|540|126
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]|600.00||||600.00|191.4|540|126
100267|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|INSERT ACETABULAR ENDO II -3 MM TAPER HIP|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|600.00||||600.00|390|540|126
100267|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|INSERT ACETABULAR ENDO II -3 MM TAPER HIP|<Self-pay>|<Self-pay>|600.00||||600.00|180|540|126
100267|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|INSERT ACETABULAR ENDO II -3 MM TAPER HIP|HEALTHNET [1495]|HEALTHNET [149500]|600.00||||600.00|540|540|126
100267|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|INSERT ACETABULAR ENDO II -3 MM TAPER HIP|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|600.00||||600.00|540|540|126
100267|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|INSERT ACETABULAR ENDO II -3 MM TAPER HIP|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|600.00||||600.00|540|540|126
100267|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|INSERT ACETABULAR ENDO II -3 MM TAPER HIP|CIGNA [1260]|CIGNA - GREAT WEST [126009]|600.00||||600.00|420|540|126
100267|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|INSERT ACETABULAR ENDO II -3 MM TAPER HIP|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|600.00||||600.00|540|540|126
100267|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|INSERT ACETABULAR ENDO II -3 MM TAPER HIP|FMH BENEFIT SERVICES [1390]|FMH [139000]|600.00||||600.00|540|540|126
100267|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|INSERT ACETABULAR ENDO II -3 MM TAPER HIP|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|600.00||||600.00|198|540|126
100267|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|INSERT ACETABULAR ENDO II -3 MM TAPER HIP|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|600.00||||600.00|126|540|126
100267|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|INSERT ACETABULAR ENDO II -3 MM TAPER HIP|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|600.00||||600.00|300|540|126
100267|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|INSERT ACETABULAR ENDO II -3 MM TAPER HIP|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|600.00||||600.00|540|540|126
100267|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|INSERT ACETABULAR ENDO II -3 MM TAPER HIP|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|600.00||||600.00|300|540|126
100267|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|INSERT ACETABULAR ENDO II -3 MM TAPER HIP|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|600.00||||600.00|258|540|126
100267|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|INSERT ACETABULAR ENDO II -3 MM TAPER HIP|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|600.00||||600.00|462|540|126
100267|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|INSERT ACETABULAR ENDO II -3 MM TAPER HIP|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|600.00||||600.00|540|540|126
100267|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|INSERT ACETABULAR ENDO II -3 MM TAPER HIP|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|600.00||||600.00|540|540|126
100267|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|INSERT ACETABULAR ENDO II -3 MM TAPER HIP|SAMBA HEALTH [2305]|SAMBA HEALTH [230500]|600.00||||600.00|420|540|126
100267|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|INSERT ACETABULAR ENDO II -3 MM TAPER HIP|TRUSTMARK [2030]|STARMARK [203000]|600.00||||600.00|540|540|126
100267|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|INSERT ACETABULAR ENDO II -3 MM TAPER HIP|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|600.00||||600.00|540|540|126
100267|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|INSERT ACETABULAR ENDO II -3 MM TAPER HIP|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|600.00||||600.00|||
100267|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|INSERT ACETABULAR ENDO II -3 MM TAPER HIP|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|600.00||||600.00|||
100267|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|INSERT ACETABULAR ENDO II -3 MM TAPER HIP|UNITED HEALTHCARE [2060]|UHC MEDICA CHOICE [206030]|600.00||||600.00|||
100267|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|INSERT ACETABULAR ENDO II -3 MM TAPER HIP|GEHA [1415]|GEHA - ASA [141503]|600.00||||600.00|||
100267|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|INSERT ACETABULAR ENDO II -3 MM TAPER HIP|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|600.00||||600.00|||
100267|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|INSERT ACETABULAR ENDO II -3 MM TAPER HIP|MULTIPLAN [1680]|HMA [168003]|600.00||||600.00|||
100267|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|INSERT ACETABULAR ENDO II -3 MM TAPER HIP|AETNA [1015]|AETNA ACO WILCO [101532]|600.00||||600.00|||
100267|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|INSERT ACETABULAR ENDO II -3 MM TAPER HIP|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|600.00||||600.00|||
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]|600.00||||600.00|||
100267|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|INSERT ACETABULAR ENDO II -3 MM TAPER HIP|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|600.00||||600.00|||
100267|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|INSERT ACETABULAR ENDO II -3 MM TAPER HIP|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|600.00||||600.00|||
100267|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|INSERT ACETABULAR ENDO II -3 MM TAPER HIP|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|600.00||||600.00|||
100267|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|INSERT ACETABULAR ENDO II -3 MM TAPER HIP|CHAMPVA [1240]|CHAMP VA [124000]|600.00||||600.00|||
100267|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|INSERT ACETABULAR ENDO II -3 MM TAPER HIP|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|600.00||||600.00|||
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]|600.00||||600.00|||
100267|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|INSERT ACETABULAR ENDO II -3 MM TAPER HIP|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|600.00||||600.00|||
100267|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|INSERT ACETABULAR ENDO II -3 MM TAPER HIP|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|600.00||||600.00|||
100267|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|INSERT ACETABULAR ENDO II -3 MM TAPER HIP|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|600.00||||600.00|||
100267|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|INSERT ACETABULAR ENDO II -3 MM TAPER HIP|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|600.00||||600.00|||
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]|600.00||||600.00|||
100267|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|INSERT ACETABULAR ENDO II -3 MM TAPER HIP|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|600.00||||600.00|||
100267|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|INSERT ACETABULAR ENDO II -3 MM TAPER HIP|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|600.00||||600.00|||
100267|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|INSERT ACETABULAR ENDO II -3 MM TAPER HIP|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|600.00||||600.00|||
100267|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|INSERT ACETABULAR ENDO II -3 MM TAPER HIP|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|600.00||||600.00|||
100267|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|INSERT ACETABULAR ENDO II -3 MM TAPER HIP|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|600.00||||600.00|||
100267|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|INSERT ACETABULAR ENDO II -3 MM TAPER HIP|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|600.00||||600.00|||
100267|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|INSERT ACETABULAR ENDO II -3 MM TAPER HIP|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|600.00||||600.00|||
100267|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|INSERT ACETABULAR ENDO II -3 MM TAPER HIP|UMR [2035]|UMR OPTIONS [203501]|600.00||||600.00|||
100267|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|INSERT ACETABULAR ENDO II -3 MM TAPER HIP|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|600.00||||600.00|||
100268|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|CENTRALIZER STEM 16MM HIP DISTAL PMMA POSITIONER STERILE|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|300.00||||300.00|231|270|63
100268|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|CENTRALIZER STEM 16MM HIP DISTAL PMMA POSITIONER STERILE|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|300.00||||300.00|270|270|63
100268|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|CENTRALIZER STEM 16MM HIP DISTAL PMMA POSITIONER STERILE|GROUP PENSION ADMIN [1450]|GPA [145000]|300.00||||300.00|210|270|63
100268|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|CENTRALIZER STEM 16MM HIP DISTAL PMMA POSITIONER STERILE|TRUSTMARK [2030]|STARMARK [203000]|300.00||||300.00|270|270|63
100268|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|CENTRALIZER STEM 16MM HIP DISTAL PMMA POSITIONER STERILE|CORESOURCE [1315]|CORESOURCE [131500]|300.00||||300.00|270|270|63
100268|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|CENTRALIZER STEM 16MM HIP DISTAL PMMA POSITIONER STERILE|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|300.00||||300.00|195|270|63
100268|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|CENTRALIZER STEM 16MM HIP DISTAL PMMA POSITIONER STERILE|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|300.00||||300.00|270|270|63
100268|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|CENTRALIZER STEM 16MM HIP DISTAL PMMA POSITIONER STERILE|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|300.00||||300.00|270|270|63
100268|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|CENTRALIZER STEM 16MM HIP DISTAL PMMA POSITIONER STERILE|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|300.00||||300.00|121.5|270|63
100268|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|CENTRALIZER STEM 16MM HIP DISTAL PMMA POSITIONER STERILE|AETNA [1015]|AMERICAN CONTINENTAL [101507]|300.00||||300.00|210|270|63
100268|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|CENTRALIZER STEM 16MM HIP DISTAL PMMA POSITIONER STERILE|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|300.00||||300.00|195|270|63
100268|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|CENTRALIZER STEM 16MM HIP DISTAL PMMA POSITIONER STERILE|SAMBA HEALTH [2305]|SAMBA HEALTH [230500]|300.00||||300.00|210|270|63
100268|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|CENTRALIZER STEM 16MM HIP DISTAL PMMA POSITIONER STERILE|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|300.00||||300.00|150|270|63
100268|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|CENTRALIZER STEM 16MM HIP DISTAL PMMA POSITIONER STERILE|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|300.00||||300.00|270|270|63
100268|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|CENTRALIZER STEM 16MM HIP DISTAL PMMA POSITIONER STERILE|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|300.00||||300.00|270|270|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]|300.00||||300.00|95.7|270|63
100268|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|CENTRALIZER STEM 16MM HIP DISTAL PMMA POSITIONER STERILE|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|300.00||||300.00|173.7|270|63
100268|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|CENTRALIZER STEM 16MM HIP DISTAL PMMA POSITIONER STERILE|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|300.00||||300.00|270|270|63
100268|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|CENTRALIZER STEM 16MM HIP DISTAL PMMA POSITIONER STERILE|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|300.00||||300.00|270|270|63
100268|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|CENTRALIZER STEM 16MM HIP DISTAL PMMA POSITIONER STERILE|FMH BENEFIT SERVICES [1390]|FMH [139000]|300.00||||300.00|270|270|63
100268|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|CENTRALIZER STEM 16MM HIP DISTAL PMMA POSITIONER STERILE|FIRST HEALTH [1375]|QUALCHOICE [137513]|300.00||||300.00|270|270|63
100268|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|CENTRALIZER STEM 16MM HIP DISTAL PMMA POSITIONER STERILE|CIGNA [1260]|CIGNA - GREAT WEST [126009]|300.00||||300.00|210|270|63
100268|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|CENTRALIZER STEM 16MM HIP DISTAL PMMA POSITIONER STERILE|<Self-pay>|<Self-pay>|300.00||||300.00|90|270|63
100268|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|CENTRALIZER STEM 16MM HIP DISTAL PMMA POSITIONER STERILE|HEALTHNET [1495]|HEALTHNET [149500]|300.00||||300.00|270|270|63
100268|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|CENTRALIZER STEM 16MM HIP DISTAL PMMA POSITIONER STERILE|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|300.00||||300.00|270|270|63
100268|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|CENTRALIZER STEM 16MM HIP DISTAL PMMA POSITIONER STERILE|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|300.00||||300.00|129|270|63
100268|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|CENTRALIZER STEM 16MM HIP DISTAL PMMA POSITIONER STERILE|AETNA [1015]|COVENTRY HEALTHCARE [101502]|300.00||||300.00|270|270|63
100268|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|CENTRALIZER STEM 16MM HIP DISTAL PMMA POSITIONER STERILE|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|300.00||||300.00|270|270|63
100268|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|CENTRALIZER STEM 16MM HIP DISTAL PMMA POSITIONER STERILE|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|300.00||||300.00|150|270|63
100268|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|CENTRALIZER STEM 16MM HIP DISTAL PMMA POSITIONER STERILE|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|300.00||||300.00|63|270|63
100268|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|CENTRALIZER STEM 16MM HIP DISTAL PMMA POSITIONER STERILE|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|300.00||||300.00|99|270|63
100268|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|CENTRALIZER STEM 16MM HIP DISTAL PMMA POSITIONER STERILE|FIRST HEALTH [1375]|BENVEO/UCS [137512]|300.00||||300.00|255|270|63
100268|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|CENTRALIZER STEM 16MM HIP DISTAL PMMA POSITIONER STERILE|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|300.00||||300.00|270|270|63
100268|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|CENTRALIZER STEM 16MM HIP DISTAL PMMA POSITIONER STERILE|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|300.00||||300.00|270|270|63
100268|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|CENTRALIZER STEM 16MM HIP DISTAL PMMA POSITIONER STERILE|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|300.00||||300.00|147.6|270|63
100268|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|CENTRALIZER STEM 16MM HIP DISTAL PMMA POSITIONER STERILE|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|300.00||||300.00|195|270|63
100268|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|CENTRALIZER STEM 16MM HIP DISTAL PMMA POSITIONER STERILE|MULTIPLAN [1680]|IHC HS [168011]|300.00||||300.00|270|270|63
100268|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|CENTRALIZER STEM 16MM HIP DISTAL PMMA POSITIONER STERILE|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|300.00||||300.00|270|270|63
100268|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|CENTRALIZER STEM 16MM HIP DISTAL PMMA POSITIONER STERILE|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|300.00||||300.00|270|270|63
100268|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|CENTRALIZER STEM 16MM HIP DISTAL PMMA POSITIONER STERILE|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|300.00||||300.00|270|270|63
100268|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|CENTRALIZER STEM 16MM HIP DISTAL PMMA POSITIONER STERILE|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|300.00||||300.00|129|270|63
100268|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|CENTRALIZER STEM 16MM HIP DISTAL PMMA POSITIONER STERILE|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|300.00||||300.00|270|270|63
100268|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|CENTRALIZER STEM 16MM HIP DISTAL PMMA POSITIONER STERILE|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|300.00||||300.00|||
100268|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|CENTRALIZER STEM 16MM HIP DISTAL PMMA POSITIONER STERILE|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|300.00||||300.00|||
100268|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|CENTRALIZER STEM 16MM HIP DISTAL PMMA POSITIONER STERILE|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|300.00||||300.00|||
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]|300.00||||300.00|||
100268|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|CENTRALIZER STEM 16MM HIP DISTAL PMMA POSITIONER STERILE|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|300.00||||300.00|||
100268|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|CENTRALIZER STEM 16MM HIP DISTAL PMMA POSITIONER STERILE|GEHA [1415]|GEHA - ASA [141503]|300.00||||300.00|||
100268|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|CENTRALIZER STEM 16MM HIP DISTAL PMMA POSITIONER STERILE|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|300.00||||300.00|||
100268|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|CENTRALIZER STEM 16MM HIP DISTAL PMMA POSITIONER STERILE|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|300.00||||300.00|||
100268|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|CENTRALIZER STEM 16MM HIP DISTAL PMMA POSITIONER STERILE|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|300.00||||300.00|||
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]|300.00||||300.00|||
100268|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|CENTRALIZER STEM 16MM HIP DISTAL PMMA POSITIONER STERILE|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|300.00||||300.00|||
100268|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|CENTRALIZER STEM 16MM HIP DISTAL PMMA POSITIONER STERILE|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|300.00||||300.00|||
100268|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|CENTRALIZER STEM 16MM HIP DISTAL PMMA POSITIONER STERILE|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|300.00||||300.00|||
100268|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|CENTRALIZER STEM 16MM HIP DISTAL PMMA POSITIONER STERILE|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|300.00||||300.00|||
100268|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|CENTRALIZER STEM 16MM HIP DISTAL PMMA POSITIONER STERILE|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|300.00||||300.00|||
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]|300.00||||300.00|||
100268|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|CENTRALIZER STEM 16MM HIP DISTAL PMMA POSITIONER STERILE|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|300.00||||300.00|||
100268|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|CENTRALIZER STEM 16MM HIP DISTAL PMMA POSITIONER STERILE|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|300.00||||300.00|||
100268|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|CENTRALIZER STEM 16MM HIP DISTAL PMMA POSITIONER STERILE|AETNA [1015]|AETNA ACO WILCO [101532]|300.00||||300.00|||
100268|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|CENTRALIZER STEM 16MM HIP DISTAL PMMA POSITIONER STERILE|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|300.00||||300.00|||
100268|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|CENTRALIZER STEM 16MM HIP DISTAL PMMA POSITIONER STERILE|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|300.00||||300.00|||
100268|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|CENTRALIZER STEM 16MM HIP DISTAL PMMA POSITIONER STERILE|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|300.00||||300.00|||
100268|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|CENTRALIZER STEM 16MM HIP DISTAL PMMA POSITIONER STERILE|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|300.00||||300.00|||
100268|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|CENTRALIZER STEM 16MM HIP DISTAL PMMA POSITIONER STERILE|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|300.00||||300.00|||
100268|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|CENTRALIZER STEM 16MM HIP DISTAL PMMA POSITIONER STERILE|UMR [2035]|UMR OPTIONS [203501]|300.00||||300.00|||
100268|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|CENTRALIZER STEM 16MM HIP DISTAL PMMA POSITIONER STERILE|UNITED HEALTHCARE [2060]|UHC MEDICA CHOICE [206030]|300.00||||300.00|||
100268|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|CENTRALIZER STEM 16MM HIP DISTAL PMMA POSITIONER STERILE|CHAMPVA [1240]|CHAMP VA [124000]|300.00||||300.00|||
100268|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|CENTRALIZER STEM 16MM HIP DISTAL PMMA POSITIONER STERILE|MULTIPLAN [1680]|HMA [168003]|300.00||||300.00|||
100268|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|CENTRALIZER STEM 16MM HIP DISTAL PMMA POSITIONER STERILE|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|300.00||||300.00|||
100269|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD UNIPOLAR 57MM ENDO II HIP ACETABULUM COCRMO MODULAR|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|1200.00||||1200.00|516|1080|252
100269|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD UNIPOLAR 57MM ENDO II HIP ACETABULUM COCRMO MODULAR|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|1200.00||||1200.00|1080|1080|252
100269|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD UNIPOLAR 57MM ENDO II HIP ACETABULUM COCRMO MODULAR|CORESOURCE [1315]|CORESOURCE [131500]|1200.00||||1200.00|1080|1080|252
100269|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD UNIPOLAR 57MM ENDO II HIP ACETABULUM COCRMO MODULAR|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|1200.00||||1200.00|1080|1080|252
100269|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD UNIPOLAR 57MM ENDO II HIP ACETABULUM COCRMO MODULAR|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|1200.00||||1200.00|694.8|1080|252
100269|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD UNIPOLAR 57MM ENDO II HIP ACETABULUM COCRMO MODULAR|AETNA [1015]|COVENTRY HEALTHCARE [101502]|1200.00||||1200.00|1080|1080|252
100269|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD UNIPOLAR 57MM ENDO II HIP ACETABULUM COCRMO MODULAR|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|1200.00||||1200.00|486|1080|252
100269|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD UNIPOLAR 57MM ENDO II HIP ACETABULUM COCRMO MODULAR|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|1200.00||||1200.00|780|1080|252
100269|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD UNIPOLAR 57MM ENDO II HIP ACETABULUM COCRMO MODULAR|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|1200.00||||1200.00|252|1080|252
100269|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD UNIPOLAR 57MM ENDO II HIP ACETABULUM COCRMO MODULAR|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|1200.00||||1200.00|590.4|1080|252
100269|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD UNIPOLAR 57MM ENDO II HIP ACETABULUM COCRMO MODULAR|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|1200.00||||1200.00|1080|1080|252
100269|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD UNIPOLAR 57MM ENDO II HIP ACETABULUM COCRMO MODULAR|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|1200.00||||1200.00|1080|1080|252
100269|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD UNIPOLAR 57MM ENDO II HIP ACETABULUM COCRMO MODULAR|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|1200.00||||1200.00|382.8|1080|252
100269|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD UNIPOLAR 57MM ENDO II HIP ACETABULUM COCRMO MODULAR|TRUSTMARK [2030]|STARMARK [203000]|1200.00||||1200.00|1080|1080|252
100269|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD UNIPOLAR 57MM ENDO II HIP ACETABULUM COCRMO MODULAR|AETNA [1015]|AMERICAN CONTINENTAL [101507]|1200.00||||1200.00|840|1080|252
100269|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD UNIPOLAR 57MM ENDO II HIP ACETABULUM COCRMO MODULAR|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|1200.00||||1200.00|1080|1080|252
100269|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD UNIPOLAR 57MM ENDO II HIP ACETABULUM COCRMO MODULAR|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|1200.00||||1200.00|600|1080|252
100269|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD UNIPOLAR 57MM ENDO II HIP ACETABULUM COCRMO MODULAR|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|1200.00||||1200.00|1080|1080|252
100269|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD UNIPOLAR 57MM ENDO II HIP ACETABULUM COCRMO MODULAR|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|1200.00||||1200.00|1080|1080|252
100269|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD UNIPOLAR 57MM ENDO II HIP ACETABULUM COCRMO MODULAR|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|1200.00||||1200.00|1080|1080|252
100269|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD UNIPOLAR 57MM ENDO II HIP ACETABULUM COCRMO MODULAR|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|1200.00||||1200.00|1080|1080|252
100269|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD UNIPOLAR 57MM ENDO II HIP ACETABULUM COCRMO MODULAR|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|1200.00||||1200.00|1080|1080|252
100269|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD UNIPOLAR 57MM ENDO II HIP ACETABULUM COCRMO MODULAR|SAMBA HEALTH [2305]|SAMBA HEALTH [230500]|1200.00||||1200.00|840|1080|252
100269|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD UNIPOLAR 57MM ENDO II HIP ACETABULUM COCRMO MODULAR|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|1200.00||||1200.00|1080|1080|252
100269|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD UNIPOLAR 57MM ENDO II HIP ACETABULUM COCRMO MODULAR|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|1200.00||||1200.00|396|1080|252
100269|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD UNIPOLAR 57MM ENDO II HIP ACETABULUM COCRMO MODULAR|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|1200.00||||1200.00|924|1080|252
100269|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD UNIPOLAR 57MM ENDO II HIP ACETABULUM COCRMO MODULAR|MULTIPLAN [1680]|IHC HS [168011]|1200.00||||1200.00|1080|1080|252
100269|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD UNIPOLAR 57MM ENDO II HIP ACETABULUM COCRMO MODULAR|FMH BENEFIT SERVICES [1390]|FMH [139000]|1200.00||||1200.00|1080|1080|252
100269|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD UNIPOLAR 57MM ENDO II HIP ACETABULUM COCRMO MODULAR|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|1200.00||||1200.00|516|1080|252
100269|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD UNIPOLAR 57MM ENDO II HIP ACETABULUM COCRMO MODULAR|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|1200.00||||1200.00|600|1080|252
100269|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD UNIPOLAR 57MM ENDO II HIP ACETABULUM COCRMO MODULAR|FIRST HEALTH [1375]|BENVEO/UCS [137512]|1200.00||||1200.00|1020|1080|252
100269|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD UNIPOLAR 57MM ENDO II HIP ACETABULUM COCRMO MODULAR|GROUP PENSION ADMIN [1450]|GPA [145000]|1200.00||||1200.00|840|1080|252
100269|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD UNIPOLAR 57MM ENDO II HIP ACETABULUM COCRMO MODULAR|<Self-pay>|<Self-pay>|1200.00||||1200.00|360|1080|252
100269|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD UNIPOLAR 57MM ENDO II HIP ACETABULUM COCRMO MODULAR|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|1200.00||||1200.00|1080|1080|252
100269|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD UNIPOLAR 57MM ENDO II HIP ACETABULUM COCRMO MODULAR|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|1200.00||||1200.00|1080|1080|252
100269|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD UNIPOLAR 57MM ENDO II HIP ACETABULUM COCRMO MODULAR|FIRST HEALTH [1375]|QUALCHOICE [137513]|1200.00||||1200.00|1080|1080|252
100269|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD UNIPOLAR 57MM ENDO II HIP ACETABULUM COCRMO MODULAR|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|1200.00||||1200.00|780|1080|252
100269|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD UNIPOLAR 57MM ENDO II HIP ACETABULUM COCRMO MODULAR|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|1200.00||||1200.00|780|1080|252
100269|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD UNIPOLAR 57MM ENDO II HIP ACETABULUM COCRMO MODULAR|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|1200.00||||1200.00|1080|1080|252
100269|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD UNIPOLAR 57MM ENDO II HIP ACETABULUM COCRMO MODULAR|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|1200.00||||1200.00|1080|1080|252
100269|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD UNIPOLAR 57MM ENDO II HIP ACETABULUM COCRMO MODULAR|HEALTHNET [1495]|HEALTHNET [149500]|1200.00||||1200.00|1080|1080|252
100269|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD UNIPOLAR 57MM ENDO II HIP ACETABULUM COCRMO MODULAR|CIGNA [1260]|CIGNA - GREAT WEST [126009]|1200.00||||1200.00|840|1080|252
100269|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD UNIPOLAR 57MM ENDO II HIP ACETABULUM COCRMO MODULAR|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|1200.00||||1200.00|||
100269|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD UNIPOLAR 57MM ENDO II HIP ACETABULUM COCRMO MODULAR|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|1200.00||||1200.00|||
100269|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD UNIPOLAR 57MM ENDO II HIP ACETABULUM COCRMO MODULAR|AETNA [1015]|AETNA ACO WILCO [101532]|1200.00||||1200.00|||
100269|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD UNIPOLAR 57MM ENDO II HIP ACETABULUM COCRMO MODULAR|CHAMPVA [1240]|CHAMP VA [124000]|1200.00||||1200.00|||
100269|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD UNIPOLAR 57MM ENDO II HIP ACETABULUM COCRMO MODULAR|UMR [2035]|UMR OPTIONS [203501]|1200.00||||1200.00|||
100269|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD UNIPOLAR 57MM ENDO II HIP ACETABULUM COCRMO MODULAR|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|1200.00||||1200.00|||
100269|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD UNIPOLAR 57MM ENDO II HIP ACETABULUM COCRMO MODULAR|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|1200.00||||1200.00|||
100269|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD UNIPOLAR 57MM ENDO II HIP ACETABULUM COCRMO MODULAR|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|1200.00||||1200.00|||
100269|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD UNIPOLAR 57MM ENDO II HIP ACETABULUM COCRMO MODULAR|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|1200.00||||1200.00|||
100269|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD UNIPOLAR 57MM ENDO II HIP ACETABULUM COCRMO MODULAR|MULTIPLAN [1680]|HMA [168003]|1200.00||||1200.00|||
100269|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD UNIPOLAR 57MM ENDO II HIP ACETABULUM COCRMO MODULAR|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|1200.00||||1200.00|||
100269|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD UNIPOLAR 57MM ENDO II HIP ACETABULUM COCRMO MODULAR|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|1200.00||||1200.00|||
100269|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD UNIPOLAR 57MM ENDO II HIP ACETABULUM COCRMO MODULAR|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|1200.00||||1200.00|||
100269|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD UNIPOLAR 57MM ENDO II HIP ACETABULUM COCRMO MODULAR|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|1200.00||||1200.00|||
100269|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD UNIPOLAR 57MM ENDO II HIP ACETABULUM COCRMO MODULAR|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|1200.00||||1200.00|||
100269|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD UNIPOLAR 57MM ENDO II HIP ACETABULUM COCRMO MODULAR|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|1200.00||||1200.00|||
100269|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD UNIPOLAR 57MM ENDO II HIP ACETABULUM COCRMO MODULAR|UNITED HEALTHCARE [2060]|UHC MEDICA CHOICE [206030]|1200.00||||1200.00|||
100269|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD UNIPOLAR 57MM ENDO II HIP ACETABULUM COCRMO MODULAR|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|1200.00||||1200.00|||
100269|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD UNIPOLAR 57MM ENDO II HIP ACETABULUM COCRMO MODULAR|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|1200.00||||1200.00|||
100269|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD UNIPOLAR 57MM ENDO II HIP ACETABULUM COCRMO MODULAR|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|1200.00||||1200.00|||
100269|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD UNIPOLAR 57MM ENDO II HIP ACETABULUM COCRMO MODULAR|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|1200.00||||1200.00|||
100269|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD UNIPOLAR 57MM ENDO II HIP ACETABULUM COCRMO MODULAR|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|1200.00||||1200.00|||
100269|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD UNIPOLAR 57MM ENDO II HIP ACETABULUM COCRMO MODULAR|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|1200.00||||1200.00|||
100269|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD UNIPOLAR 57MM ENDO II HIP ACETABULUM COCRMO MODULAR|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|1200.00||||1200.00|||
100269|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD UNIPOLAR 57MM ENDO II HIP ACETABULUM COCRMO MODULAR|GEHA [1415]|GEHA - ASA [141503]|1200.00||||1200.00|||
100269|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD UNIPOLAR 57MM ENDO II HIP ACETABULUM COCRMO MODULAR|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|1200.00||||1200.00|||
100269|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD UNIPOLAR 57MM ENDO II HIP ACETABULUM COCRMO MODULAR|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|1200.00||||1200.00|||
100269|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD UNIPOLAR 57MM ENDO II HIP ACETABULUM COCRMO MODULAR|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|1200.00||||1200.00|||
100269|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD UNIPOLAR 57MM ENDO II HIP ACETABULUM COCRMO MODULAR|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|1200.00||||1200.00|||
10027|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L12 MM OD3.5 MM ODSEC6 MM CORTEX SELF TAP LOW PROFILE HEAD SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|101.24||||101.24|77.95|91.12|21.26
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 TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|101.24||||101.24|91.12|91.12|21.26
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|FMH BENEFIT SERVICES [1390]|FMH [139000]|101.24||||101.24|91.12|91.12|21.26
10027|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L12 MM OD3.5 MM ODSEC6 MM CORTEX SELF TAP LOW PROFILE HEAD SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|101.24||||101.24|50.62|91.12|21.26
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|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|101.24||||101.24|21.26|91.12|21.26
10027|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L12 MM OD3.5 MM ODSEC6 MM CORTEX SELF TAP LOW PROFILE HEAD SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|101.24||||101.24|91.12|91.12|21.26
10027|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L12 MM OD3.5 MM ODSEC6 MM CORTEX SELF TAP LOW PROFILE HEAD SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|101.24||||101.24|50.62|91.12|21.26
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|CORESOURCE [1315]|CORESOURCE [131500]|101.24||||101.24|91.12|91.12|21.26
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 MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|101.24||||101.24|91.12|91.12|21.26
10027|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L12 MM OD3.5 MM ODSEC6 MM CORTEX SELF TAP LOW PROFILE HEAD SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|HEALTHNET [1495]|HEALTHNET [149500]|101.24||||101.24|91.12|91.12|21.26
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]|101.24||||101.24|33.41|91.12|21.26
10027|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L12 MM OD3.5 MM ODSEC6 MM CORTEX SELF TAP LOW PROFILE HEAD SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|101.24||||101.24|43.53|91.12|21.26
10027|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L12 MM OD3.5 MM ODSEC6 MM CORTEX SELF TAP LOW PROFILE HEAD SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|101.24||||101.24|91.12|91.12|21.26
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|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|101.24||||101.24|65.81|91.12|21.26
10027|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L12 MM OD3.5 MM ODSEC6 MM CORTEX SELF TAP LOW PROFILE HEAD SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|101.24||||101.24|91.12|91.12|21.26
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]|101.24||||101.24|32.3|91.12|21.26
10027|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L12 MM OD3.5 MM ODSEC6 MM CORTEX SELF TAP LOW PROFILE HEAD SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|101.24||||101.24|91.12|91.12|21.26
10027|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L12 MM OD3.5 MM ODSEC6 MM CORTEX SELF TAP LOW PROFILE HEAD SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|101.24||||101.24|49.81|91.12|21.26
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 HEALTH CARE [132000]|101.24||||101.24|91.12|91.12|21.26
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]|101.24||||101.24|91.12|91.12|21.26
10027|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L12 MM OD3.5 MM ODSEC6 MM CORTEX SELF TAP LOW PROFILE HEAD SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|101.24||||101.24|43.53|91.12|21.26
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]|COVENTRY HEALTHCARE [101502]|101.24||||101.24|91.12|91.12|21.26
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]|AMERICAN CONTINENTAL [101507]|101.24||||101.24|70.87|91.12|21.26
10027|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L12 MM OD3.5 MM ODSEC6 MM CORTEX SELF TAP LOW PROFILE HEAD SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|101.24||||101.24|58.62|91.12|21.26
10027|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L12 MM OD3.5 MM ODSEC6 MM CORTEX SELF TAP LOW PROFILE HEAD SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|101.24||||101.24|91.12|91.12|21.26
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 - GREAT WEST [126009]|101.24||||101.24|70.87|91.12|21.26
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>|101.24||||101.24|30.37|91.12|21.26
10027|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L12 MM OD3.5 MM ODSEC6 MM CORTEX SELF TAP LOW PROFILE HEAD SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|101.24||||101.24|91.12|91.12|21.26
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|GROUP PENSION ADMIN [1450]|GPA [145000]|101.24||||101.24|70.87|91.12|21.26
10027|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L12 MM OD3.5 MM ODSEC6 MM CORTEX SELF TAP LOW PROFILE HEAD SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|101.24||||101.24|41|91.12|21.26
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]|BENVEO/UCS [137512]|101.24||||101.24|86.05|91.12|21.26
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|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|101.24||||101.24|65.81|91.12|21.26
10027|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L12 MM OD3.5 MM ODSEC6 MM CORTEX SELF TAP LOW PROFILE HEAD SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|MULTIPLAN [1680]|IHC HS [168011]|101.24||||101.24|91.12|91.12|21.26
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|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|101.24||||101.24|65.81|91.12|21.26
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|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|101.24||||101.24|91.12|91.12|21.26
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]|QUALCHOICE [137513]|101.24||||101.24|91.12|91.12|21.26
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|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|101.24||||101.24|91.12|91.12|21.26
10027|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L12 MM OD3.5 MM ODSEC6 MM CORTEX SELF TAP LOW PROFILE HEAD SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|101.24||||101.24|91.12|91.12|21.26
10027|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L12 MM OD3.5 MM ODSEC6 MM CORTEX SELF TAP LOW PROFILE HEAD SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|101.24||||101.24|91.12|91.12|21.26
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|SAMBA HEALTH [2305]|SAMBA HEALTH [230500]|101.24||||101.24|70.87|91.12|21.26
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|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|101.24||||101.24|91.12|91.12|21.26
10027|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L12 MM OD3.5 MM ODSEC6 MM CORTEX SELF TAP LOW PROFILE HEAD SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|TRUSTMARK [2030]|STARMARK [203000]|101.24||||101.24|91.12|91.12|21.26
10027|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L12 MM OD3.5 MM ODSEC6 MM CORTEX SELF TAP LOW PROFILE HEAD SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|101.24||||101.24|||
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|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|101.24||||101.24|||
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 MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|101.24||||101.24|||
10027|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L12 MM OD3.5 MM ODSEC6 MM CORTEX SELF TAP LOW PROFILE HEAD SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|101.24||||101.24|||
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 MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|101.24||||101.24|||
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|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|101.24||||101.24|||
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|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|101.24||||101.24|||
10027|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L12 MM OD3.5 MM ODSEC6 MM CORTEX SELF TAP LOW PROFILE HEAD SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|101.24||||101.24|||
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]|101.24||||101.24|||
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]|101.24||||101.24|||
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|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|101.24||||101.24|||
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]|101.24||||101.24|||
10027|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L12 MM OD3.5 MM ODSEC6 MM CORTEX SELF TAP LOW PROFILE HEAD SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|101.24||||101.24|||
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]|101.24||||101.24|||
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|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|101.24||||101.24|||
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]|101.24||||101.24|||
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]|101.24||||101.24|||
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]|101.24||||101.24|||
10027|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L12 MM OD3.5 MM ODSEC6 MM CORTEX SELF TAP LOW PROFILE HEAD SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|GEHA [1415]|GEHA - ASA [141503]|101.24||||101.24|||
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]|101.24||||101.24|||
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 MEDICARE SUPPLEMENT [101514]|101.24||||101.24|||
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]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|101.24||||101.24|||
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 IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|101.24||||101.24|||
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|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|101.24||||101.24|||
10027|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L12 MM OD3.5 MM ODSEC6 MM CORTEX SELF TAP LOW PROFILE HEAD SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|101.24||||101.24|||
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|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|101.24||||101.24|||
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|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|101.24||||101.24|||
10027|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L12 MM OD3.5 MM ODSEC6 MM CORTEX SELF TAP LOW PROFILE HEAD SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|101.24||||101.24|||
10027|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L12 MM OD3.5 MM ODSEC6 MM CORTEX SELF TAP LOW PROFILE HEAD SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|UMR [2035]|UMR OPTIONS [203501]|101.24||||101.24|||
100271|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE REUNION L24 MM OD6.5 MM CENTER STERILE|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|475.00||||475.00|308.75|427.5|99.75
100271|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE REUNION L24 MM OD6.5 MM CENTER STERILE|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|475.00||||475.00|427.5|427.5|99.75
100271|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE REUNION L24 MM OD6.5 MM CENTER STERILE|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|475.00||||475.00|237.5|427.5|99.75
100271|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE REUNION L24 MM OD6.5 MM CENTER STERILE|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|475.00||||475.00|427.5|427.5|99.75
100271|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE REUNION L24 MM OD6.5 MM CENTER STERILE|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|475.00||||475.00|151.53|427.5|99.75
100271|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE REUNION L24 MM OD6.5 MM CENTER STERILE|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|475.00||||475.00|427.5|427.5|99.75
100271|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE REUNION L24 MM OD6.5 MM CENTER STERILE|HEALTHNET [1495]|HEALTHNET [149500]|475.00||||475.00|427.5|427.5|99.75
100271|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE REUNION L24 MM OD6.5 MM CENTER STERILE|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|475.00||||475.00|427.5|427.5|99.75
100271|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE REUNION L24 MM OD6.5 MM CENTER STERILE|CIGNA [1260]|CIGNA - GREAT WEST [126009]|475.00||||475.00|332.5|427.5|99.75
100271|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE REUNION L24 MM OD6.5 MM CENTER STERILE|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|475.00||||475.00|427.5|427.5|99.75
100271|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE REUNION L24 MM OD6.5 MM CENTER STERILE|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|475.00||||475.00|427.5|427.5|99.75
100271|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE REUNION L24 MM OD6.5 MM CENTER STERILE|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|475.00||||475.00|427.5|427.5|99.75
100271|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE REUNION L24 MM OD6.5 MM CENTER STERILE|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|475.00||||475.00|427.5|427.5|99.75
100271|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE REUNION L24 MM OD6.5 MM CENTER STERILE|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|475.00||||475.00|365.75|427.5|99.75
100271|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE REUNION L24 MM OD6.5 MM CENTER STERILE|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|475.00||||475.00|204.25|427.5|99.75
100271|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE REUNION L24 MM OD6.5 MM CENTER STERILE|FMH BENEFIT SERVICES [1390]|FMH [139000]|475.00||||475.00|427.5|427.5|99.75
100271|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE REUNION L24 MM OD6.5 MM CENTER STERILE|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|475.00||||475.00|237.5|427.5|99.75
100271|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE REUNION L24 MM OD6.5 MM CENTER STERILE|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|475.00||||475.00|156.75|427.5|99.75
100271|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE REUNION L24 MM OD6.5 MM CENTER STERILE|CORESOURCE [1315]|CORESOURCE [131500]|475.00||||475.00|427.5|427.5|99.75
100271|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE REUNION L24 MM OD6.5 MM CENTER STERILE|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|475.00||||475.00|99.75|427.5|99.75
100271|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE REUNION L24 MM OD6.5 MM CENTER STERILE|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|475.00||||475.00|427.5|427.5|99.75
100271|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE REUNION L24 MM OD6.5 MM CENTER STERILE|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|475.00||||475.00|192.38|427.5|99.75
100271|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE REUNION L24 MM OD6.5 MM CENTER STERILE|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|475.00||||475.00|427.5|427.5|99.75
100271|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE REUNION L24 MM OD6.5 MM CENTER STERILE|TRUSTMARK [2030]|STARMARK [203000]|475.00||||475.00|427.5|427.5|99.75
100271|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE REUNION L24 MM OD6.5 MM CENTER STERILE|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|475.00||||475.00|427.5|427.5|99.75
100271|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE REUNION L24 MM OD6.5 MM CENTER STERILE|SAMBA HEALTH [2305]|SAMBA HEALTH [230500]|475.00||||475.00|332.5|427.5|99.75
100271|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE REUNION L24 MM OD6.5 MM CENTER STERILE|GROUP PENSION ADMIN [1450]|GPA [145000]|475.00||||475.00|332.5|427.5|99.75
100271|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE REUNION L24 MM OD6.5 MM CENTER STERILE|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|475.00||||475.00|427.5|427.5|99.75
100271|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE REUNION L24 MM OD6.5 MM CENTER STERILE|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|475.00||||475.00|308.75|427.5|99.75
100271|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE REUNION L24 MM OD6.5 MM CENTER STERILE|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|475.00||||475.00|427.5|427.5|99.75
100271|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE REUNION L24 MM OD6.5 MM CENTER STERILE|<Self-pay>|<Self-pay>|475.00||||475.00|142.5|427.5|99.75
100271|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE REUNION L24 MM OD6.5 MM CENTER STERILE|FIRST HEALTH [1375]|BENVEO/UCS [137512]|475.00||||475.00|403.75|427.5|99.75
100271|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE REUNION L24 MM OD6.5 MM CENTER STERILE|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|475.00||||475.00|233.7|427.5|99.75
100271|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE REUNION L24 MM OD6.5 MM CENTER STERILE|MULTIPLAN [1680]|IHC HS [168011]|475.00||||475.00|427.5|427.5|99.75
100271|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE REUNION L24 MM OD6.5 MM CENTER STERILE|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|475.00||||475.00|204.25|427.5|99.75
100271|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE REUNION L24 MM OD6.5 MM CENTER STERILE|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|475.00||||475.00|308.75|427.5|99.75
100271|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE REUNION L24 MM OD6.5 MM CENTER STERILE|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|475.00||||475.00|427.5|427.5|99.75
100271|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE REUNION L24 MM OD6.5 MM CENTER STERILE|AETNA [1015]|COVENTRY HEALTHCARE [101502]|475.00||||475.00|427.5|427.5|99.75
100271|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE REUNION L24 MM OD6.5 MM CENTER STERILE|AETNA [1015]|AMERICAN CONTINENTAL [101507]|475.00||||475.00|332.5|427.5|99.75
100271|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE REUNION L24 MM OD6.5 MM CENTER STERILE|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|475.00||||475.00|427.5|427.5|99.75
100271|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE REUNION L24 MM OD6.5 MM CENTER STERILE|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|475.00||||475.00|275.03|427.5|99.75
100271|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE REUNION L24 MM OD6.5 MM CENTER STERILE|FIRST HEALTH [1375]|QUALCHOICE [137513]|475.00||||475.00|427.5|427.5|99.75
100271|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE REUNION L24 MM OD6.5 MM CENTER STERILE|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|475.00||||475.00|||
100271|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE REUNION L24 MM OD6.5 MM CENTER STERILE|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|475.00||||475.00|||
100271|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE REUNION L24 MM OD6.5 MM CENTER STERILE|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|475.00||||475.00|||
100271|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE REUNION L24 MM OD6.5 MM CENTER STERILE|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|475.00||||475.00|||
100271|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE REUNION L24 MM OD6.5 MM CENTER STERILE|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|475.00||||475.00|||
100271|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE REUNION L24 MM OD6.5 MM CENTER STERILE|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|475.00||||475.00|||
100271|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE REUNION L24 MM OD6.5 MM CENTER STERILE|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|475.00||||475.00|||
100271|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE REUNION L24 MM OD6.5 MM CENTER STERILE|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|475.00||||475.00|||
100271|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE REUNION L24 MM OD6.5 MM CENTER STERILE|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|475.00||||475.00|||
100271|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE REUNION L24 MM OD6.5 MM CENTER STERILE|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|475.00||||475.00|||
100271|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE REUNION L24 MM OD6.5 MM CENTER STERILE|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|475.00||||475.00|||
100271|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE REUNION L24 MM OD6.5 MM CENTER STERILE|CHAMPVA [1240]|CHAMP VA [124000]|475.00||||475.00|||
100271|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE REUNION L24 MM OD6.5 MM CENTER STERILE|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|475.00||||475.00|||
100271|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE REUNION L24 MM OD6.5 MM CENTER STERILE|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|475.00||||475.00|||
100271|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE REUNION L24 MM OD6.5 MM CENTER STERILE|UMR [2035]|UMR OPTIONS [203501]|475.00||||475.00|||
100271|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE REUNION L24 MM OD6.5 MM CENTER STERILE|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|475.00||||475.00|||
100271|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE REUNION L24 MM OD6.5 MM CENTER STERILE|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|475.00||||475.00|||
100271|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE REUNION L24 MM OD6.5 MM CENTER STERILE|GEHA [1415]|GEHA - ASA [141503]|475.00||||475.00|||
100271|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE REUNION L24 MM OD6.5 MM CENTER STERILE|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|475.00||||475.00|||
100271|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE REUNION L24 MM OD6.5 MM CENTER STERILE|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|475.00||||475.00|||
100271|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE REUNION L24 MM OD6.5 MM CENTER STERILE|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|475.00||||475.00|||
100271|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE REUNION L24 MM OD6.5 MM CENTER STERILE|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|475.00||||475.00|||
100271|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE REUNION L24 MM OD6.5 MM CENTER STERILE|MULTIPLAN [1680]|HMA [168003]|475.00||||475.00|||
100271|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE REUNION L24 MM OD6.5 MM CENTER STERILE|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|475.00||||475.00|||
100271|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE REUNION L24 MM OD6.5 MM CENTER STERILE|AETNA [1015]|AETNA ACO WILCO [101532]|475.00||||475.00|||
100271|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE REUNION L24 MM OD6.5 MM CENTER STERILE|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|475.00||||475.00|||
100271|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE REUNION L24 MM OD6.5 MM CENTER STERILE|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|475.00||||475.00|||
100271|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE REUNION L24 MM OD6.5 MM CENTER STERILE|UNITED HEALTHCARE [2060]|UHC MEDICA CHOICE [206030]|475.00||||475.00|||
100271|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE REUNION L24 MM OD6.5 MM CENTER STERILE|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|475.00||||475.00|||
100272|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SPHERE GLENOID THK2 MM CONCENTRIC OD32 MM SHOULDER|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|4655.00||||4655.00|2327.5|4189.5|977.55
100272|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SPHERE GLENOID THK2 MM CONCENTRIC OD32 MM SHOULDER|AETNA [1015]|AMERICAN CONTINENTAL [101507]|4655.00||||4655.00|3258.5|4189.5|977.55
100272|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SPHERE GLENOID THK2 MM CONCENTRIC OD32 MM SHOULDER|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|4655.00||||4655.00|3584.35|4189.5|977.55
100272|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SPHERE GLENOID THK2 MM CONCENTRIC OD32 MM SHOULDER|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|4655.00||||4655.00|4189.5|4189.5|977.55
100272|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SPHERE GLENOID THK2 MM CONCENTRIC OD32 MM SHOULDER|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|4655.00||||4655.00|4189.5|4189.5|977.55
100272|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SPHERE GLENOID THK2 MM CONCENTRIC OD32 MM SHOULDER|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|4655.00||||4655.00|977.55|4189.5|977.55
100272|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SPHERE GLENOID THK2 MM CONCENTRIC OD32 MM SHOULDER|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|4655.00||||4655.00|2001.65|4189.5|977.55
100272|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SPHERE GLENOID THK2 MM CONCENTRIC OD32 MM SHOULDER|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|4655.00||||4655.00|4189.5|4189.5|977.55
100272|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SPHERE GLENOID THK2 MM CONCENTRIC OD32 MM SHOULDER|CIGNA [1260]|CIGNA - GREAT WEST [126009]|4655.00||||4655.00|3258.5|4189.5|977.55
100272|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SPHERE GLENOID THK2 MM CONCENTRIC OD32 MM SHOULDER|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|4655.00||||4655.00|4189.5|4189.5|977.55
100272|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SPHERE GLENOID THK2 MM CONCENTRIC OD32 MM SHOULDER|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|4655.00||||4655.00|1536.15|4189.5|977.55
100272|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SPHERE GLENOID THK2 MM CONCENTRIC OD32 MM SHOULDER|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|4655.00||||4655.00|2695.25|4189.5|977.55
100272|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SPHERE GLENOID THK2 MM CONCENTRIC OD32 MM SHOULDER|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|4655.00||||4655.00|4189.5|4189.5|977.55
100272|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SPHERE GLENOID THK2 MM CONCENTRIC OD32 MM SHOULDER|FMH BENEFIT SERVICES [1390]|FMH [139000]|4655.00||||4655.00|4189.5|4189.5|977.55
100272|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SPHERE GLENOID THK2 MM CONCENTRIC OD32 MM SHOULDER|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|4655.00||||4655.00|3025.75|4189.5|977.55
100272|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SPHERE GLENOID THK2 MM CONCENTRIC OD32 MM SHOULDER|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|4655.00||||4655.00|4189.5|4189.5|977.55
100272|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SPHERE GLENOID THK2 MM CONCENTRIC OD32 MM SHOULDER|AETNA [1015]|COVENTRY HEALTHCARE [101502]|4655.00||||4655.00|4189.5|4189.5|977.55
100272|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SPHERE GLENOID THK2 MM CONCENTRIC OD32 MM SHOULDER|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|4655.00||||4655.00|2327.5|4189.5|977.55
100272|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SPHERE GLENOID THK2 MM CONCENTRIC OD32 MM SHOULDER|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|4655.00||||4655.00|1885.28|4189.5|977.55
100272|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SPHERE GLENOID THK2 MM CONCENTRIC OD32 MM SHOULDER|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|4655.00||||4655.00|2290.26|4189.5|977.55
100272|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SPHERE GLENOID THK2 MM CONCENTRIC OD32 MM SHOULDER|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|4655.00||||4655.00|4189.5|4189.5|977.55
100272|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SPHERE GLENOID THK2 MM CONCENTRIC OD32 MM SHOULDER|CORESOURCE [1315]|CORESOURCE [131500]|4655.00||||4655.00|4189.5|4189.5|977.55
100272|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SPHERE GLENOID THK2 MM CONCENTRIC OD32 MM SHOULDER|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|4655.00||||4655.00|4189.5|4189.5|977.55
100272|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SPHERE GLENOID THK2 MM CONCENTRIC OD32 MM SHOULDER|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|4655.00||||4655.00|2001.65|4189.5|977.55
100272|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SPHERE GLENOID THK2 MM CONCENTRIC OD32 MM SHOULDER|HEALTHNET [1495]|HEALTHNET [149500]|4655.00||||4655.00|4189.5|4189.5|977.55
100272|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SPHERE GLENOID THK2 MM CONCENTRIC OD32 MM SHOULDER|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|4655.00||||4655.00|1629.25|4189.5|977.55
100272|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SPHERE GLENOID THK2 MM CONCENTRIC OD32 MM SHOULDER|FIRST HEALTH [1375]|BENVEO/UCS [137512]|4655.00||||4655.00|3956.75|4189.5|977.55
100272|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SPHERE GLENOID THK2 MM CONCENTRIC OD32 MM SHOULDER|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|4655.00||||4655.00|1629.25|4189.5|977.55
100272|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SPHERE GLENOID THK2 MM CONCENTRIC OD32 MM SHOULDER|MULTIPLAN [1680]|HMA [168003]|4655.00||||4655.00|1629.25|4189.5|977.55
100272|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SPHERE GLENOID THK2 MM CONCENTRIC OD32 MM SHOULDER|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|4655.00||||4655.00|3025.75|4189.5|977.55
100272|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SPHERE GLENOID THK2 MM CONCENTRIC OD32 MM SHOULDER|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|4655.00||||4655.00|4189.5|4189.5|977.55
100272|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SPHERE GLENOID THK2 MM CONCENTRIC OD32 MM SHOULDER|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|4655.00||||4655.00|3025.75|4189.5|977.55
100272|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SPHERE GLENOID THK2 MM CONCENTRIC OD32 MM SHOULDER|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|4655.00||||4655.00|4189.5|4189.5|977.55
100272|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SPHERE GLENOID THK2 MM CONCENTRIC OD32 MM SHOULDER|GROUP PENSION ADMIN [1450]|GPA [145000]|4655.00||||4655.00|3258.5|4189.5|977.55
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]|4655.00||||4655.00|1484.95|4189.5|977.55
100272|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SPHERE GLENOID THK2 MM CONCENTRIC OD32 MM SHOULDER|FIRST HEALTH [1375]|QUALCHOICE [137513]|4655.00||||4655.00|4189.5|4189.5|977.55
100272|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SPHERE GLENOID THK2 MM CONCENTRIC OD32 MM SHOULDER|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|4655.00||||4655.00|4189.5|4189.5|977.55
100272|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SPHERE GLENOID THK2 MM CONCENTRIC OD32 MM SHOULDER|TRUSTMARK [2030]|STARMARK [203000]|4655.00||||4655.00|4189.5|4189.5|977.55
100272|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SPHERE GLENOID THK2 MM CONCENTRIC OD32 MM SHOULDER|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|4655.00||||4655.00|4189.5|4189.5|977.55
100272|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SPHERE GLENOID THK2 MM CONCENTRIC OD32 MM SHOULDER|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|4655.00||||4655.00|4189.5|4189.5|977.55
100272|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SPHERE GLENOID THK2 MM CONCENTRIC OD32 MM SHOULDER|SAMBA HEALTH [2305]|SAMBA HEALTH [230500]|4655.00||||4655.00|3258.5|4189.5|977.55
100272|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SPHERE GLENOID THK2 MM CONCENTRIC OD32 MM SHOULDER|MULTIPLAN [1680]|IHC HS [168011]|4655.00||||4655.00|4189.5|4189.5|977.55
100272|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SPHERE GLENOID THK2 MM CONCENTRIC OD32 MM SHOULDER|<Self-pay>|<Self-pay>|4655.00||||4655.00|1396.5|4189.5|977.55
100272|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SPHERE GLENOID THK2 MM CONCENTRIC OD32 MM SHOULDER|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|4655.00||||4655.00|4189.5|4189.5|977.55
100272|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SPHERE GLENOID THK2 MM CONCENTRIC OD32 MM SHOULDER|AETNA [1015]|AETNA ACO WILCO [101532]|4655.00||||4655.00|1629.25|4189.5|977.55
100272|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SPHERE GLENOID THK2 MM CONCENTRIC OD32 MM SHOULDER|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|4655.00||||4655.00|4189.5|4189.5|977.55
100272|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SPHERE GLENOID THK2 MM CONCENTRIC OD32 MM SHOULDER|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|4655.00||||4655.00|||
100272|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SPHERE GLENOID THK2 MM CONCENTRIC OD32 MM SHOULDER|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|4655.00||||4655.00|||
100272|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SPHERE GLENOID THK2 MM CONCENTRIC OD32 MM SHOULDER|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|4655.00||||4655.00|||
100272|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SPHERE GLENOID THK2 MM CONCENTRIC OD32 MM SHOULDER|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|4655.00||||4655.00|||
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]|4655.00||||4655.00|||
100272|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SPHERE GLENOID THK2 MM CONCENTRIC OD32 MM SHOULDER|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|4655.00||||4655.00|||
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]|4655.00||||4655.00|||
100272|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SPHERE GLENOID THK2 MM CONCENTRIC OD32 MM SHOULDER|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|4655.00||||4655.00|||
100272|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SPHERE GLENOID THK2 MM CONCENTRIC OD32 MM SHOULDER|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|4655.00||||4655.00|||
100272|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SPHERE GLENOID THK2 MM CONCENTRIC OD32 MM SHOULDER|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|4655.00||||4655.00|||
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]|4655.00||||4655.00|||
100272|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SPHERE GLENOID THK2 MM CONCENTRIC OD32 MM SHOULDER|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|4655.00||||4655.00|||
100272|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SPHERE GLENOID THK2 MM CONCENTRIC OD32 MM SHOULDER|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|4655.00||||4655.00|||
100272|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SPHERE GLENOID THK2 MM CONCENTRIC OD32 MM SHOULDER|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|4655.00||||4655.00|||
100272|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SPHERE GLENOID THK2 MM CONCENTRIC OD32 MM SHOULDER|GEHA [1415]|GEHA - ASA [141503]|4655.00||||4655.00|||
100272|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SPHERE GLENOID THK2 MM CONCENTRIC OD32 MM SHOULDER|CHAMPVA [1240]|CHAMP VA [124000]|4655.00||||4655.00|||
100272|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SPHERE GLENOID THK2 MM CONCENTRIC OD32 MM SHOULDER|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|4655.00||||4655.00|||
100272|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SPHERE GLENOID THK2 MM CONCENTRIC OD32 MM SHOULDER|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|4655.00||||4655.00|||
100272|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SPHERE GLENOID THK2 MM CONCENTRIC OD32 MM SHOULDER|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|4655.00||||4655.00|||
100272|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SPHERE GLENOID THK2 MM CONCENTRIC OD32 MM SHOULDER|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|4655.00||||4655.00|||
100272|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SPHERE GLENOID THK2 MM CONCENTRIC OD32 MM SHOULDER|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|4655.00||||4655.00|||
100272|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SPHERE GLENOID THK2 MM CONCENTRIC OD32 MM SHOULDER|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|4655.00||||4655.00|||
100272|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SPHERE GLENOID THK2 MM CONCENTRIC OD32 MM SHOULDER|UMR [2035]|UMR OPTIONS [203501]|4655.00||||4655.00|||
100272|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SPHERE GLENOID THK2 MM CONCENTRIC OD32 MM SHOULDER|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|4655.00||||4655.00|||
100272|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SPHERE GLENOID THK2 MM CONCENTRIC OD32 MM SHOULDER|UNITED HEALTHCARE [2060]|UHC MEDICA CHOICE [206030]|4655.00||||4655.00|||
100273|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW PERIPHERAL 4.5X20MM|TRUSTMARK [2030]|STARMARK [203000]|475.00||||475.00|427.5|427.5|99.75
100273|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW PERIPHERAL 4.5X20MM|SAMBA HEALTH [2305]|SAMBA HEALTH [230500]|475.00||||475.00|332.5|427.5|99.75
100273|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW PERIPHERAL 4.5X20MM|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|475.00||||475.00|427.5|427.5|99.75
100273|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW PERIPHERAL 4.5X20MM|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|475.00||||475.00|427.5|427.5|99.75
100273|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW PERIPHERAL 4.5X20MM|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|475.00||||475.00|427.5|427.5|99.75
100273|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW PERIPHERAL 4.5X20MM|FIRST HEALTH [1375]|QUALCHOICE [137513]|475.00||||475.00|427.5|427.5|99.75
100273|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW PERIPHERAL 4.5X20MM|FIRST HEALTH [1375]|BENVEO/UCS [137512]|475.00||||475.00|403.75|427.5|99.75
100273|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW PERIPHERAL 4.5X20MM|<Self-pay>|<Self-pay>|475.00||||475.00|142.5|427.5|99.75
100273|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW PERIPHERAL 4.5X20MM|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|475.00||||475.00|427.5|427.5|99.75
100273|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW PERIPHERAL 4.5X20MM|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|475.00||||475.00|427.5|427.5|99.75
100273|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW PERIPHERAL 4.5X20MM|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|475.00||||475.00|204.25|427.5|99.75
100273|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW PERIPHERAL 4.5X20MM|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|475.00||||475.00|427.5|427.5|99.75
100273|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW PERIPHERAL 4.5X20MM|AETNA [1015]|COVENTRY HEALTHCARE [101502]|475.00||||475.00|427.5|427.5|99.75
100273|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW PERIPHERAL 4.5X20MM|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|475.00||||475.00|308.75|427.5|99.75
100273|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW PERIPHERAL 4.5X20MM|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|475.00||||475.00|308.75|427.5|99.75
100273|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW PERIPHERAL 4.5X20MM|GROUP PENSION ADMIN [1450]|GPA [145000]|475.00||||475.00|332.5|427.5|99.75
100273|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW PERIPHERAL 4.5X20MM|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|475.00||||475.00|275.03|427.5|99.75
100273|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW PERIPHERAL 4.5X20MM|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|475.00||||475.00|427.5|427.5|99.75
100273|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW PERIPHERAL 4.5X20MM|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|475.00||||475.00|308.75|427.5|99.75
100273|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW PERIPHERAL 4.5X20MM|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|475.00||||475.00|427.5|427.5|99.75
100273|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW PERIPHERAL 4.5X20MM|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|475.00||||475.00|192.38|427.5|99.75
100273|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW PERIPHERAL 4.5X20MM|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|475.00||||475.00|233.7|427.5|99.75
100273|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW PERIPHERAL 4.5X20MM|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|475.00||||475.00|427.5|427.5|99.75
100273|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW PERIPHERAL 4.5X20MM|CORESOURCE [1315]|CORESOURCE [131500]|475.00||||475.00|427.5|427.5|99.75
100273|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW PERIPHERAL 4.5X20MM|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|475.00||||475.00|151.53|427.5|99.75
100273|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW PERIPHERAL 4.5X20MM|MULTIPLAN [1680]|IHC HS [168011]|475.00||||475.00|427.5|427.5|99.75
100273|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW PERIPHERAL 4.5X20MM|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|475.00||||475.00|427.5|427.5|99.75
100273|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW PERIPHERAL 4.5X20MM|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|475.00||||475.00|156.75|427.5|99.75
100273|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW PERIPHERAL 4.5X20MM|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|475.00||||475.00|427.5|427.5|99.75
100273|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW PERIPHERAL 4.5X20MM|FMH BENEFIT SERVICES [1390]|FMH [139000]|475.00||||475.00|427.5|427.5|99.75
100273|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW PERIPHERAL 4.5X20MM|HEALTHNET [1495]|HEALTHNET [149500]|475.00||||475.00|427.5|427.5|99.75
100273|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW PERIPHERAL 4.5X20MM|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|475.00||||475.00|427.5|427.5|99.75
100273|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW PERIPHERAL 4.5X20MM|AETNA [1015]|AMERICAN CONTINENTAL [101507]|475.00||||475.00|332.5|427.5|99.75
100273|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW PERIPHERAL 4.5X20MM|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|475.00||||475.00|365.75|427.5|99.75
100273|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW PERIPHERAL 4.5X20MM|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|475.00||||475.00|237.5|427.5|99.75
100273|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW PERIPHERAL 4.5X20MM|CIGNA [1260]|CIGNA - GREAT WEST [126009]|475.00||||475.00|332.5|427.5|99.75
100273|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW PERIPHERAL 4.5X20MM|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|475.00||||475.00|427.5|427.5|99.75
100273|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW PERIPHERAL 4.5X20MM|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|475.00||||475.00|427.5|427.5|99.75
100273|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW PERIPHERAL 4.5X20MM|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|475.00||||475.00|204.25|427.5|99.75
100273|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW PERIPHERAL 4.5X20MM|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|475.00||||475.00|237.5|427.5|99.75
100273|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW PERIPHERAL 4.5X20MM|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|475.00||||475.00|99.75|427.5|99.75
100273|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW PERIPHERAL 4.5X20MM|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|475.00||||475.00|427.5|427.5|99.75
100273|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW PERIPHERAL 4.5X20MM|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|475.00||||475.00|||
100273|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW PERIPHERAL 4.5X20MM|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|475.00||||475.00|||
100273|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW PERIPHERAL 4.5X20MM|AETNA [1015]|AETNA ACO WILCO [101532]|475.00||||475.00|||
100273|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW PERIPHERAL 4.5X20MM|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|475.00||||475.00|||
100273|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW PERIPHERAL 4.5X20MM|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|475.00||||475.00|||
100273|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW PERIPHERAL 4.5X20MM|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|475.00||||475.00|||
100273|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW PERIPHERAL 4.5X20MM|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|475.00||||475.00|||
100273|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW PERIPHERAL 4.5X20MM|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|475.00||||475.00|||
100273|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW PERIPHERAL 4.5X20MM|UNITED HEALTHCARE [2060]|UHC MEDICA CHOICE [206030]|475.00||||475.00|||
100273|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW PERIPHERAL 4.5X20MM|MULTIPLAN [1680]|HMA [168003]|475.00||||475.00|||
100273|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW PERIPHERAL 4.5X20MM|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|475.00||||475.00|||
100273|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW PERIPHERAL 4.5X20MM|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|475.00||||475.00|||
100273|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW PERIPHERAL 4.5X20MM|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|475.00||||475.00|||
100273|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW PERIPHERAL 4.5X20MM|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|475.00||||475.00|||
100273|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW PERIPHERAL 4.5X20MM|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|475.00||||475.00|||
100273|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW PERIPHERAL 4.5X20MM|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|475.00||||475.00|||
100273|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW PERIPHERAL 4.5X20MM|UMR [2035]|UMR OPTIONS [203501]|475.00||||475.00|||
100273|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW PERIPHERAL 4.5X20MM|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|475.00||||475.00|||
100273|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW PERIPHERAL 4.5X20MM|GEHA [1415]|GEHA - ASA [141503]|475.00||||475.00|||
100273|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW PERIPHERAL 4.5X20MM|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|475.00||||475.00|||
100273|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW PERIPHERAL 4.5X20MM|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|475.00||||475.00|||
100273|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW PERIPHERAL 4.5X20MM|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|475.00||||475.00|||
100273|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW PERIPHERAL 4.5X20MM|CHAMPVA [1240]|CHAMP VA [124000]|475.00||||475.00|||
100273|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW PERIPHERAL 4.5X20MM|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|475.00||||475.00|||
100273|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW PERIPHERAL 4.5X20MM|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|475.00||||475.00|||
100273|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW PERIPHERAL 4.5X20MM|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|475.00||||475.00|||
100273|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW PERIPHERAL 4.5X20MM|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|475.00||||475.00|||
100273|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW PERIPHERAL 4.5X20MM|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|475.00||||475.00|||
100273|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW PERIPHERAL 4.5X20MM|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|475.00||||475.00|||
100274|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|CUP HUMERAL THK4 MM OD32 MM SHOULDER|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|4655.00||||4655.00|2327.5|4189.5|977.55
100274|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|CUP HUMERAL THK4 MM OD32 MM SHOULDER|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|4655.00||||4655.00|2001.65|4189.5|977.55
100274|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|CUP HUMERAL THK4 MM OD32 MM SHOULDER|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|4655.00||||4655.00|3584.35|4189.5|977.55
100274|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|CUP HUMERAL THK4 MM OD32 MM SHOULDER|FMH BENEFIT SERVICES [1390]|FMH [139000]|4655.00||||4655.00|4189.5|4189.5|977.55
100274|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|CUP HUMERAL THK4 MM OD32 MM SHOULDER|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|4655.00||||4655.00|2327.5|4189.5|977.55
100274|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|CUP HUMERAL THK4 MM OD32 MM SHOULDER|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|4655.00||||4655.00|1484.95|4189.5|977.55
100274|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|CUP HUMERAL THK4 MM OD32 MM SHOULDER|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|4655.00||||4655.00|977.55|4189.5|977.55
100274|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|CUP HUMERAL THK4 MM OD32 MM SHOULDER|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|4655.00||||4655.00|4189.5|4189.5|977.55
100274|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|CUP HUMERAL THK4 MM OD32 MM SHOULDER|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|4655.00||||4655.00|4189.5|4189.5|977.55
100274|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|CUP HUMERAL THK4 MM OD32 MM SHOULDER|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|4655.00||||4655.00|4189.5|4189.5|977.55
100274|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|CUP HUMERAL THK4 MM OD32 MM SHOULDER|CIGNA [1260]|CIGNA - GREAT WEST [126009]|4655.00||||4655.00|3258.5|4189.5|977.55
100274|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|CUP HUMERAL THK4 MM OD32 MM SHOULDER|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|4655.00||||4655.00|4189.5|4189.5|977.55
100274|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|CUP HUMERAL THK4 MM OD32 MM SHOULDER|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|4655.00||||4655.00|2001.65|4189.5|977.55
100274|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|CUP HUMERAL THK4 MM OD32 MM SHOULDER|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|4655.00||||4655.00|4189.5|4189.5|977.55
100274|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|CUP HUMERAL THK4 MM OD32 MM SHOULDER|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|4655.00||||4655.00|4189.5|4189.5|977.55
100274|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|CUP HUMERAL THK4 MM OD32 MM SHOULDER|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|4655.00||||4655.00|1885.28|4189.5|977.55
100274|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|CUP HUMERAL THK4 MM OD32 MM SHOULDER|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|4655.00||||4655.00|4189.5|4189.5|977.55
100274|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|CUP HUMERAL THK4 MM OD32 MM SHOULDER|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|4655.00||||4655.00|1536.15|4189.5|977.55
100274|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|CUP HUMERAL THK4 MM OD32 MM SHOULDER|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|4655.00||||4655.00|2695.25|4189.5|977.55
100274|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|CUP HUMERAL THK4 MM OD32 MM SHOULDER|CORESOURCE [1315]|CORESOURCE [131500]|4655.00||||4655.00|4189.5|4189.5|977.55
100274|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|CUP HUMERAL THK4 MM OD32 MM SHOULDER|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|4655.00||||4655.00|4189.5|4189.5|977.55
100274|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|CUP HUMERAL THK4 MM OD32 MM SHOULDER|AETNA [1015]|COVENTRY HEALTHCARE [101502]|4655.00||||4655.00|4189.5|4189.5|977.55
100274|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|CUP HUMERAL THK4 MM OD32 MM SHOULDER|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|4655.00||||4655.00|1629.25|4189.5|977.55
100274|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|CUP HUMERAL THK4 MM OD32 MM SHOULDER|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|4655.00||||4655.00|3025.75|4189.5|977.55
100274|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|CUP HUMERAL THK4 MM OD32 MM SHOULDER|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|4655.00||||4655.00|2290.26|4189.5|977.55
100274|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|CUP HUMERAL THK4 MM OD32 MM SHOULDER|TRUSTMARK [2030]|STARMARK [203000]|4655.00||||4655.00|4189.5|4189.5|977.55
100274|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|CUP HUMERAL THK4 MM OD32 MM SHOULDER|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|4655.00||||4655.00|3025.75|4189.5|977.55
100274|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|CUP HUMERAL THK4 MM OD32 MM SHOULDER|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|4655.00||||4655.00|4189.5|4189.5|977.55
100274|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|CUP HUMERAL THK4 MM OD32 MM SHOULDER|MULTIPLAN [1680]|IHC HS [168011]|4655.00||||4655.00|4189.5|4189.5|977.55
100274|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|CUP HUMERAL THK4 MM OD32 MM SHOULDER|AETNA [1015]|AMERICAN CONTINENTAL [101507]|4655.00||||4655.00|3258.5|4189.5|977.55
100274|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|CUP HUMERAL THK4 MM OD32 MM SHOULDER|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|4655.00||||4655.00|4189.5|4189.5|977.55
100274|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|CUP HUMERAL THK4 MM OD32 MM SHOULDER|FIRST HEALTH [1375]|BENVEO/UCS [137512]|4655.00||||4655.00|3956.75|4189.5|977.55
100274|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|CUP HUMERAL THK4 MM OD32 MM SHOULDER|HEALTHNET [1495]|HEALTHNET [149500]|4655.00||||4655.00|4189.5|4189.5|977.55
100274|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|CUP HUMERAL THK4 MM OD32 MM SHOULDER|<Self-pay>|<Self-pay>|4655.00||||4655.00|1396.5|4189.5|977.55
100274|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|CUP HUMERAL THK4 MM OD32 MM SHOULDER|FIRST HEALTH [1375]|QUALCHOICE [137513]|4655.00||||4655.00|4189.5|4189.5|977.55
100274|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|CUP HUMERAL THK4 MM OD32 MM SHOULDER|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|4655.00||||4655.00|4189.5|4189.5|977.55
100274|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|CUP HUMERAL THK4 MM OD32 MM SHOULDER|AETNA [1015]|AETNA ACO WILCO [101532]|4655.00||||4655.00|1629.25|4189.5|977.55
100274|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|CUP HUMERAL THK4 MM OD32 MM SHOULDER|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|4655.00||||4655.00|4189.5|4189.5|977.55
100274|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|CUP HUMERAL THK4 MM OD32 MM SHOULDER|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|4655.00||||4655.00|4189.5|4189.5|977.55
100274|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|CUP HUMERAL THK4 MM OD32 MM SHOULDER|SAMBA HEALTH [2305]|SAMBA HEALTH [230500]|4655.00||||4655.00|3258.5|4189.5|977.55
100274|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|CUP HUMERAL THK4 MM OD32 MM SHOULDER|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|4655.00||||4655.00|4189.5|4189.5|977.55
100274|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|CUP HUMERAL THK4 MM OD32 MM SHOULDER|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|4655.00||||4655.00|3025.75|4189.5|977.55
100274|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|CUP HUMERAL THK4 MM OD32 MM SHOULDER|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|4655.00||||4655.00|4189.5|4189.5|977.55
100274|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|CUP HUMERAL THK4 MM OD32 MM SHOULDER|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|4655.00||||4655.00|1629.25|4189.5|977.55
100274|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|CUP HUMERAL THK4 MM OD32 MM SHOULDER|GROUP PENSION ADMIN [1450]|GPA [145000]|4655.00||||4655.00|3258.5|4189.5|977.55
100274|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|CUP HUMERAL THK4 MM OD32 MM SHOULDER|MULTIPLAN [1680]|HMA [168003]|4655.00||||4655.00|1629.25|4189.5|977.55
100274|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|CUP HUMERAL THK4 MM OD32 MM SHOULDER|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|4655.00||||4655.00|||
100274|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|CUP HUMERAL THK4 MM OD32 MM SHOULDER|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|4655.00||||4655.00|||
100274|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|CUP HUMERAL THK4 MM OD32 MM SHOULDER|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|4655.00||||4655.00|||
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]|4655.00||||4655.00|||
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]|4655.00||||4655.00|||
100274|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|CUP HUMERAL THK4 MM OD32 MM SHOULDER|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|4655.00||||4655.00|||
100274|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|CUP HUMERAL THK4 MM OD32 MM SHOULDER|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|4655.00||||4655.00|||
100274|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|CUP HUMERAL THK4 MM OD32 MM SHOULDER|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|4655.00||||4655.00|||
100274|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|CUP HUMERAL THK4 MM OD32 MM SHOULDER|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|4655.00||||4655.00|||
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]|4655.00||||4655.00|||
100274|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|CUP HUMERAL THK4 MM OD32 MM SHOULDER|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|4655.00||||4655.00|||
100274|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|CUP HUMERAL THK4 MM OD32 MM SHOULDER|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|4655.00||||4655.00|||
100274|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|CUP HUMERAL THK4 MM OD32 MM SHOULDER|GEHA [1415]|GEHA - ASA [141503]|4655.00||||4655.00|||
100274|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|CUP HUMERAL THK4 MM OD32 MM SHOULDER|UMR [2035]|UMR OPTIONS [203501]|4655.00||||4655.00|||
100274|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|CUP HUMERAL THK4 MM OD32 MM SHOULDER|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|4655.00||||4655.00|||
100274|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|CUP HUMERAL THK4 MM OD32 MM SHOULDER|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|4655.00||||4655.00|||
100274|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|CUP HUMERAL THK4 MM OD32 MM SHOULDER|UNITED HEALTHCARE [2060]|UHC MEDICA CHOICE [206030]|4655.00||||4655.00|||
100274|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|CUP HUMERAL THK4 MM OD32 MM SHOULDER|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|4655.00||||4655.00|||
100274|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|CUP HUMERAL THK4 MM OD32 MM SHOULDER|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|4655.00||||4655.00|||
100274|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|CUP HUMERAL THK4 MM OD32 MM SHOULDER|CHAMPVA [1240]|CHAMP VA [124000]|4655.00||||4655.00|||
100274|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|CUP HUMERAL THK4 MM OD32 MM SHOULDER|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|4655.00||||4655.00|||
100274|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|CUP HUMERAL THK4 MM OD32 MM SHOULDER|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|4655.00||||4655.00|||
100274|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|CUP HUMERAL THK4 MM OD32 MM SHOULDER|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|4655.00||||4655.00|||
100274|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|CUP HUMERAL THK4 MM OD32 MM SHOULDER|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|4655.00||||4655.00|||
100274|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|CUP HUMERAL THK4 MM OD32 MM SHOULDER|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|4655.00||||4655.00|||
100275|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|INSERT HUMERAL X3 STANDARD H4 MM OD32 MM SHOULDER|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|3800.00||||3800.00|1634|3420|798
100275|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|INSERT HUMERAL X3 STANDARD H4 MM OD32 MM SHOULDER|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|3800.00||||3800.00|2926|3420|798
100275|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|INSERT HUMERAL X3 STANDARD H4 MM OD32 MM SHOULDER|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|3800.00||||3800.00|3420|3420|798
100275|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|INSERT HUMERAL X3 STANDARD H4 MM OD32 MM SHOULDER|SAMBA HEALTH [2305]|SAMBA HEALTH [230500]|3800.00||||3800.00|2660|3420|798
100275|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|INSERT HUMERAL X3 STANDARD H4 MM OD32 MM SHOULDER|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|3800.00||||3800.00|3420|3420|798
100275|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|INSERT HUMERAL X3 STANDARD H4 MM OD32 MM SHOULDER|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|3800.00||||3800.00|2470|3420|798
100275|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|INSERT HUMERAL X3 STANDARD H4 MM OD32 MM SHOULDER|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|3800.00||||3800.00|3420|3420|798
100275|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|INSERT HUMERAL X3 STANDARD H4 MM OD32 MM SHOULDER|<Self-pay>|<Self-pay>|3800.00||||3800.00|1140|3420|798
100275|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|INSERT HUMERAL X3 STANDARD H4 MM OD32 MM SHOULDER|FIRST HEALTH [1375]|BENVEO/UCS [137512]|3800.00||||3800.00|3230|3420|798
100275|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|INSERT HUMERAL X3 STANDARD H4 MM OD32 MM SHOULDER|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|3800.00||||3800.00|2470|3420|798
100275|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|INSERT HUMERAL X3 STANDARD H4 MM OD32 MM SHOULDER|FIRST HEALTH [1375]|QUALCHOICE [137513]|3800.00||||3800.00|3420|3420|798
100275|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|INSERT HUMERAL X3 STANDARD H4 MM OD32 MM SHOULDER|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|3800.00||||3800.00|3420|3420|798
100275|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|INSERT HUMERAL X3 STANDARD H4 MM OD32 MM SHOULDER|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|3800.00||||3800.00|3420|3420|798
100275|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|INSERT HUMERAL X3 STANDARD H4 MM OD32 MM SHOULDER|AETNA [1015]|AETNA ACO WILCO [101532]|3800.00||||3800.00|1330|3420|798
100275|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|INSERT HUMERAL X3 STANDARD H4 MM OD32 MM SHOULDER|AETNA [1015]|AMERICAN CONTINENTAL [101507]|3800.00||||3800.00|2660|3420|798
100275|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|INSERT HUMERAL X3 STANDARD H4 MM OD32 MM SHOULDER|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|3800.00||||3800.00|3420|3420|798
100275|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|INSERT HUMERAL X3 STANDARD H4 MM OD32 MM SHOULDER|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|3800.00||||3800.00|1869.6|3420|798
100275|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|INSERT HUMERAL X3 STANDARD H4 MM OD32 MM SHOULDER|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|3800.00||||3800.00|1634|3420|798
100275|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|INSERT HUMERAL X3 STANDARD H4 MM OD32 MM SHOULDER|GROUP PENSION ADMIN [1450]|GPA [145000]|3800.00||||3800.00|2660|3420|798
100275|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|INSERT HUMERAL X3 STANDARD H4 MM OD32 MM SHOULDER|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|3800.00||||3800.00|2200.2|3420|798
100275|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|INSERT HUMERAL X3 STANDARD H4 MM OD32 MM SHOULDER|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|3800.00||||3800.00|3420|3420|798
100275|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|INSERT HUMERAL X3 STANDARD H4 MM OD32 MM SHOULDER|MULTIPLAN [1680]|HMA [168003]|3800.00||||3800.00|1330|3420|798
100275|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|INSERT HUMERAL X3 STANDARD H4 MM OD32 MM SHOULDER|AETNA [1015]|COVENTRY HEALTHCARE [101502]|3800.00||||3800.00|3420|3420|798
100275|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|INSERT HUMERAL X3 STANDARD H4 MM OD32 MM SHOULDER|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|3800.00||||3800.00|1539|3420|798
100275|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|INSERT HUMERAL X3 STANDARD H4 MM OD32 MM SHOULDER|TRUSTMARK [2030]|STARMARK [203000]|3800.00||||3800.00|3420|3420|798
100275|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|INSERT HUMERAL X3 STANDARD H4 MM OD32 MM SHOULDER|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|3800.00||||3800.00|3420|3420|798
100275|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|INSERT HUMERAL X3 STANDARD H4 MM OD32 MM SHOULDER|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|3800.00||||3800.00|3420|3420|798
100275|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|INSERT HUMERAL X3 STANDARD H4 MM OD32 MM SHOULDER|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|3800.00||||3800.00|2470|3420|798
100275|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|INSERT HUMERAL X3 STANDARD H4 MM OD32 MM SHOULDER|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|3800.00||||3800.00|1330|3420|798
100275|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|INSERT HUMERAL X3 STANDARD H4 MM OD32 MM SHOULDER|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|3800.00||||3800.00|3420|3420|798
100275|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|INSERT HUMERAL X3 STANDARD H4 MM OD32 MM SHOULDER|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|3800.00||||3800.00|3420|3420|798
100275|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|INSERT HUMERAL X3 STANDARD H4 MM OD32 MM SHOULDER|CIGNA [1260]|CIGNA - GREAT WEST [126009]|3800.00||||3800.00|2660|3420|798
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]|3800.00||||3800.00|1212.2|3420|798
100275|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|INSERT HUMERAL X3 STANDARD H4 MM OD32 MM SHOULDER|HEALTHNET [1495]|HEALTHNET [149500]|3800.00||||3800.00|3420|3420|798
100275|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|INSERT HUMERAL X3 STANDARD H4 MM OD32 MM SHOULDER|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|3800.00||||3800.00|3420|3420|798
100275|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|INSERT HUMERAL X3 STANDARD H4 MM OD32 MM SHOULDER|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|3800.00||||3800.00|3420|3420|798
100275|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|INSERT HUMERAL X3 STANDARD H4 MM OD32 MM SHOULDER|MULTIPLAN [1680]|IHC HS [168011]|3800.00||||3800.00|3420|3420|798
100275|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|INSERT HUMERAL X3 STANDARD H4 MM OD32 MM SHOULDER|FMH BENEFIT SERVICES [1390]|FMH [139000]|3800.00||||3800.00|3420|3420|798
100275|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|INSERT HUMERAL X3 STANDARD H4 MM OD32 MM SHOULDER|CORESOURCE [1315]|CORESOURCE [131500]|3800.00||||3800.00|3420|3420|798
100275|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|INSERT HUMERAL X3 STANDARD H4 MM OD32 MM SHOULDER|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|3800.00||||3800.00|1254|3420|798
100275|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|INSERT HUMERAL X3 STANDARD H4 MM OD32 MM SHOULDER|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|3800.00||||3800.00|1330|3420|798
100275|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|INSERT HUMERAL X3 STANDARD H4 MM OD32 MM SHOULDER|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|3800.00||||3800.00|798|3420|798
100275|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|INSERT HUMERAL X3 STANDARD H4 MM OD32 MM SHOULDER|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|3800.00||||3800.00|1900|3420|798
100275|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|INSERT HUMERAL X3 STANDARD H4 MM OD32 MM SHOULDER|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|3800.00||||3800.00|3420|3420|798
100275|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|INSERT HUMERAL X3 STANDARD H4 MM OD32 MM SHOULDER|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|3800.00||||3800.00|3420|3420|798
100275|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|INSERT HUMERAL X3 STANDARD H4 MM OD32 MM SHOULDER|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|3800.00||||3800.00|1900|3420|798
100275|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|INSERT HUMERAL X3 STANDARD H4 MM OD32 MM SHOULDER|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|3800.00||||3800.00|||
100275|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|INSERT HUMERAL X3 STANDARD H4 MM OD32 MM SHOULDER|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|3800.00||||3800.00|||
100275|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|INSERT HUMERAL X3 STANDARD H4 MM OD32 MM SHOULDER|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|3800.00||||3800.00|||
100275|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|INSERT HUMERAL X3 STANDARD H4 MM OD32 MM SHOULDER|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|3800.00||||3800.00|||
100275|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|INSERT HUMERAL X3 STANDARD H4 MM OD32 MM SHOULDER|UMR [2035]|UMR OPTIONS [203501]|3800.00||||3800.00|||
100275|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|INSERT HUMERAL X3 STANDARD H4 MM OD32 MM SHOULDER|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|3800.00||||3800.00|||
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]|3800.00||||3800.00|||
100275|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|INSERT HUMERAL X3 STANDARD H4 MM OD32 MM SHOULDER|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|3800.00||||3800.00|||
100275|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|INSERT HUMERAL X3 STANDARD H4 MM OD32 MM SHOULDER|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|3800.00||||3800.00|||
100275|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|INSERT HUMERAL X3 STANDARD H4 MM OD32 MM SHOULDER|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|3800.00||||3800.00|||
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]|3800.00||||3800.00|||
100275|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|INSERT HUMERAL X3 STANDARD H4 MM OD32 MM SHOULDER|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|3800.00||||3800.00|||
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]|3800.00||||3800.00|||
100275|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|INSERT HUMERAL X3 STANDARD H4 MM OD32 MM SHOULDER|GEHA [1415]|GEHA - ASA [141503]|3800.00||||3800.00|||
100275|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|INSERT HUMERAL X3 STANDARD H4 MM OD32 MM SHOULDER|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|3800.00||||3800.00|||
100275|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|INSERT HUMERAL X3 STANDARD H4 MM OD32 MM SHOULDER|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|3800.00||||3800.00|||
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]|3800.00||||3800.00|||
100275|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|INSERT HUMERAL X3 STANDARD H4 MM OD32 MM SHOULDER|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|3800.00||||3800.00|||
100275|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|INSERT HUMERAL X3 STANDARD H4 MM OD32 MM SHOULDER|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|3800.00||||3800.00|||
100275|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|INSERT HUMERAL X3 STANDARD H4 MM OD32 MM SHOULDER|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|3800.00||||3800.00|||
100275|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|INSERT HUMERAL X3 STANDARD H4 MM OD32 MM SHOULDER|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|3800.00||||3800.00|||
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]|3800.00||||3800.00|||
100275|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|INSERT HUMERAL X3 STANDARD H4 MM OD32 MM SHOULDER|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|3800.00||||3800.00|||
100275|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|INSERT HUMERAL X3 STANDARD H4 MM OD32 MM SHOULDER|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|3800.00||||3800.00|||
100275|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|INSERT HUMERAL X3 STANDARD H4 MM OD32 MM SHOULDER|CHAMPVA [1240]|CHAMP VA [124000]|3800.00||||3800.00|||
100276|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|PUNCH OPHTHALMIC 9.5MM ULTRAFIT SET DONOR CORONET STERILE DISPOSABLE|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|279.20||||279.20|214.98|251.28|58.63
100276|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|PUNCH OPHTHALMIC 9.5MM ULTRAFIT SET DONOR CORONET STERILE DISPOSABLE|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|279.20||||279.20|120.06|251.28|58.63
100276|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|PUNCH OPHTHALMIC 9.5MM ULTRAFIT SET DONOR CORONET STERILE DISPOSABLE|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|279.20||||279.20|251.28|251.28|58.63
100276|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|PUNCH OPHTHALMIC 9.5MM ULTRAFIT SET DONOR CORONET STERILE DISPOSABLE|HEALTHNET [1495]|HEALTHNET [149500]|279.20||||279.20|251.28|251.28|58.63
100276|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|PUNCH OPHTHALMIC 9.5MM ULTRAFIT SET DONOR CORONET STERILE DISPOSABLE|FMH BENEFIT SERVICES [1390]|FMH [139000]|279.20||||279.20|251.28|251.28|58.63
100276|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|PUNCH OPHTHALMIC 9.5MM ULTRAFIT SET DONOR CORONET STERILE DISPOSABLE|CIGNA [1260]|CIGNA - GREAT WEST [126009]|279.20||||279.20|195.44|251.28|58.63
100276|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|PUNCH OPHTHALMIC 9.5MM ULTRAFIT SET DONOR CORONET STERILE DISPOSABLE|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|279.20||||279.20|251.28|251.28|58.63
100276|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|PUNCH OPHTHALMIC 9.5MM ULTRAFIT SET DONOR CORONET STERILE DISPOSABLE|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|279.20||||279.20|251.28|251.28|58.63
100276|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|PUNCH OPHTHALMIC 9.5MM ULTRAFIT SET DONOR CORONET STERILE DISPOSABLE|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|279.20||||279.20|251.28|251.28|58.63
100276|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|PUNCH OPHTHALMIC 9.5MM ULTRAFIT SET DONOR CORONET STERILE DISPOSABLE|CORESOURCE [1315]|CORESOURCE [131500]|279.20||||279.20|251.28|251.28|58.63
100276|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|PUNCH OPHTHALMIC 9.5MM ULTRAFIT SET DONOR CORONET STERILE DISPOSABLE|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|279.20||||279.20|58.63|251.28|58.63
100276|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|PUNCH OPHTHALMIC 9.5MM ULTRAFIT SET DONOR CORONET STERILE DISPOSABLE|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|279.20||||279.20|161.66|251.28|58.63
100276|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|PUNCH OPHTHALMIC 9.5MM ULTRAFIT SET DONOR CORONET STERILE DISPOSABLE|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|279.20||||279.20|251.28|251.28|58.63
100276|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|PUNCH OPHTHALMIC 9.5MM ULTRAFIT SET DONOR CORONET STERILE DISPOSABLE|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|279.20||||279.20|120.06|251.28|58.63
100276|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|PUNCH OPHTHALMIC 9.5MM ULTRAFIT SET DONOR CORONET STERILE DISPOSABLE|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|279.20||||279.20|137.37|251.28|58.63
100276|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|PUNCH OPHTHALMIC 9.5MM ULTRAFIT SET DONOR CORONET STERILE DISPOSABLE|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|279.20||||279.20|251.28|251.28|58.63
100276|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|PUNCH OPHTHALMIC 9.5MM ULTRAFIT SET DONOR CORONET STERILE DISPOSABLE|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|279.20||||279.20|92.14|251.28|58.63
100276|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|PUNCH OPHTHALMIC 9.5MM ULTRAFIT SET DONOR CORONET STERILE DISPOSABLE|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|279.20||||279.20|251.28|251.28|58.63
100276|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|PUNCH OPHTHALMIC 9.5MM ULTRAFIT SET DONOR CORONET STERILE DISPOSABLE|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|279.20||||279.20|89.06|251.28|58.63
100276|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|PUNCH OPHTHALMIC 9.5MM ULTRAFIT SET DONOR CORONET STERILE DISPOSABLE|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|279.20||||279.20|181.48|251.28|58.63
100276|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|PUNCH OPHTHALMIC 9.5MM ULTRAFIT SET DONOR CORONET STERILE DISPOSABLE|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|279.20||||279.20|113.08|251.28|58.63
100276|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|PUNCH OPHTHALMIC 9.5MM ULTRAFIT SET DONOR CORONET STERILE DISPOSABLE|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|279.20||||279.20|139.6|251.28|58.63
100276|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|PUNCH OPHTHALMIC 9.5MM ULTRAFIT SET DONOR CORONET STERILE DISPOSABLE|<Self-pay>|<Self-pay>|279.20||||279.20|83.76|251.28|58.63
100276|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|PUNCH OPHTHALMIC 9.5MM ULTRAFIT SET DONOR CORONET STERILE DISPOSABLE|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|279.20||||279.20|251.28|251.28|58.63
100276|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|PUNCH OPHTHALMIC 9.5MM ULTRAFIT SET DONOR CORONET STERILE DISPOSABLE|FIRST HEALTH [1375]|BENVEO/UCS [137512]|279.20||||279.20|237.32|251.28|58.63
100276|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|PUNCH OPHTHALMIC 9.5MM ULTRAFIT SET DONOR CORONET STERILE DISPOSABLE|FIRST HEALTH [1375]|QUALCHOICE [137513]|279.20||||279.20|251.28|251.28|58.63
100276|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|PUNCH OPHTHALMIC 9.5MM ULTRAFIT SET DONOR CORONET STERILE DISPOSABLE|GROUP PENSION ADMIN [1450]|GPA [145000]|279.20||||279.20|195.44|251.28|58.63
100276|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|PUNCH OPHTHALMIC 9.5MM ULTRAFIT SET DONOR CORONET STERILE DISPOSABLE|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|279.20||||279.20|251.28|251.28|58.63
100276|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|PUNCH OPHTHALMIC 9.5MM ULTRAFIT SET DONOR CORONET STERILE DISPOSABLE|TRUSTMARK [2030]|STARMARK [203000]|279.20||||279.20|251.28|251.28|58.63
100276|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|PUNCH OPHTHALMIC 9.5MM ULTRAFIT SET DONOR CORONET STERILE DISPOSABLE|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|279.20||||279.20|251.28|251.28|58.63
100276|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|PUNCH OPHTHALMIC 9.5MM ULTRAFIT SET DONOR CORONET STERILE DISPOSABLE|SAMBA HEALTH [2305]|SAMBA HEALTH [230500]|279.20||||279.20|195.44|251.28|58.63
100276|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|PUNCH OPHTHALMIC 9.5MM ULTRAFIT SET DONOR CORONET STERILE DISPOSABLE|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|279.20||||279.20|251.28|251.28|58.63
100276|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|PUNCH OPHTHALMIC 9.5MM ULTRAFIT SET DONOR CORONET STERILE DISPOSABLE|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|279.20||||279.20|251.28|251.28|58.63
100276|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|PUNCH OPHTHALMIC 9.5MM ULTRAFIT SET DONOR CORONET STERILE DISPOSABLE|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|279.20||||279.20|251.28|251.28|58.63
100276|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|PUNCH OPHTHALMIC 9.5MM ULTRAFIT SET DONOR CORONET STERILE DISPOSABLE|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|279.20||||279.20|181.48|251.28|58.63
100276|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|PUNCH OPHTHALMIC 9.5MM ULTRAFIT SET DONOR CORONET STERILE DISPOSABLE|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|279.20||||279.20|181.48|251.28|58.63
100276|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|PUNCH OPHTHALMIC 9.5MM ULTRAFIT SET DONOR CORONET STERILE DISPOSABLE|MULTIPLAN [1680]|IHC HS [168011]|279.20||||279.20|251.28|251.28|58.63
100276|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|PUNCH OPHTHALMIC 9.5MM ULTRAFIT SET DONOR CORONET STERILE DISPOSABLE|AETNA [1015]|COVENTRY HEALTHCARE [101502]|279.20||||279.20|251.28|251.28|58.63
100276|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|PUNCH OPHTHALMIC 9.5MM ULTRAFIT SET DONOR CORONET STERILE DISPOSABLE|AETNA [1015]|AMERICAN CONTINENTAL [101507]|279.20||||279.20|195.44|251.28|58.63
100276|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|PUNCH OPHTHALMIC 9.5MM ULTRAFIT SET DONOR CORONET STERILE DISPOSABLE|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|279.20||||279.20|251.28|251.28|58.63
100276|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|PUNCH OPHTHALMIC 9.5MM ULTRAFIT SET DONOR CORONET STERILE DISPOSABLE|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|279.20||||279.20|251.28|251.28|58.63
100276|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|PUNCH OPHTHALMIC 9.5MM ULTRAFIT SET DONOR CORONET STERILE DISPOSABLE|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|279.20||||279.20|||
100276|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|PUNCH OPHTHALMIC 9.5MM ULTRAFIT SET DONOR CORONET STERILE DISPOSABLE|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|279.20||||279.20|||
100276|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|PUNCH OPHTHALMIC 9.5MM ULTRAFIT SET DONOR CORONET STERILE DISPOSABLE|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|279.20||||279.20|||
100276|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|PUNCH OPHTHALMIC 9.5MM ULTRAFIT SET DONOR CORONET STERILE DISPOSABLE|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|279.20||||279.20|||
100276|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|PUNCH OPHTHALMIC 9.5MM ULTRAFIT SET DONOR CORONET STERILE DISPOSABLE|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|279.20||||279.20|||
100276|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|PUNCH OPHTHALMIC 9.5MM ULTRAFIT SET DONOR CORONET STERILE DISPOSABLE|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|279.20||||279.20|||
100276|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|PUNCH OPHTHALMIC 9.5MM ULTRAFIT SET DONOR CORONET STERILE DISPOSABLE|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|279.20||||279.20|||
100276|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|PUNCH OPHTHALMIC 9.5MM ULTRAFIT SET DONOR CORONET STERILE DISPOSABLE|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|279.20||||279.20|||
100276|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|PUNCH OPHTHALMIC 9.5MM ULTRAFIT SET DONOR CORONET STERILE DISPOSABLE|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|279.20||||279.20|||
100276|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|PUNCH OPHTHALMIC 9.5MM ULTRAFIT SET DONOR CORONET STERILE DISPOSABLE|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|279.20||||279.20|||
100276|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|PUNCH OPHTHALMIC 9.5MM ULTRAFIT SET DONOR CORONET STERILE DISPOSABLE|CHAMPVA [1240]|CHAMP VA [124000]|279.20||||279.20|||
100276|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|PUNCH OPHTHALMIC 9.5MM ULTRAFIT SET DONOR CORONET STERILE DISPOSABLE|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|279.20||||279.20|||
100276|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|PUNCH OPHTHALMIC 9.5MM ULTRAFIT SET DONOR CORONET STERILE DISPOSABLE|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|279.20||||279.20|||
100276|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|PUNCH OPHTHALMIC 9.5MM ULTRAFIT SET DONOR CORONET STERILE DISPOSABLE|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|279.20||||279.20|||
100276|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|PUNCH OPHTHALMIC 9.5MM ULTRAFIT SET DONOR CORONET STERILE DISPOSABLE|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|279.20||||279.20|||
100276|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|PUNCH OPHTHALMIC 9.5MM ULTRAFIT SET DONOR CORONET STERILE DISPOSABLE|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|279.20||||279.20|||
100276|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|PUNCH OPHTHALMIC 9.5MM ULTRAFIT SET DONOR CORONET STERILE DISPOSABLE|AETNA [1015]|AETNA ACO WILCO [101532]|279.20||||279.20|||
100276|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|PUNCH OPHTHALMIC 9.5MM ULTRAFIT SET DONOR CORONET STERILE DISPOSABLE|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|279.20||||279.20|||
100276|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|PUNCH OPHTHALMIC 9.5MM ULTRAFIT SET DONOR CORONET STERILE DISPOSABLE|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|279.20||||279.20|||
100276|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|PUNCH OPHTHALMIC 9.5MM ULTRAFIT SET DONOR CORONET STERILE DISPOSABLE|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|279.20||||279.20|||
100276|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|PUNCH OPHTHALMIC 9.5MM ULTRAFIT SET DONOR CORONET STERILE DISPOSABLE|UNITED HEALTHCARE [2060]|UHC MEDICA CHOICE [206030]|279.20||||279.20|||
100276|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|PUNCH OPHTHALMIC 9.5MM ULTRAFIT SET DONOR CORONET STERILE DISPOSABLE|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|279.20||||279.20|||
100276|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|PUNCH OPHTHALMIC 9.5MM ULTRAFIT SET DONOR CORONET STERILE DISPOSABLE|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|279.20||||279.20|||
100276|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|PUNCH OPHTHALMIC 9.5MM ULTRAFIT SET DONOR CORONET STERILE DISPOSABLE|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|279.20||||279.20|||
100276|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|PUNCH OPHTHALMIC 9.5MM ULTRAFIT SET DONOR CORONET STERILE DISPOSABLE|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|279.20||||279.20|||
100276|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|PUNCH OPHTHALMIC 9.5MM ULTRAFIT SET DONOR CORONET STERILE DISPOSABLE|GEHA [1415]|GEHA - ASA [141503]|279.20||||279.20|||
100276|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|PUNCH OPHTHALMIC 9.5MM ULTRAFIT SET DONOR CORONET STERILE DISPOSABLE|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|279.20||||279.20|||
100276|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|PUNCH OPHTHALMIC 9.5MM ULTRAFIT SET DONOR CORONET STERILE DISPOSABLE|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|279.20||||279.20|||
100276|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|PUNCH OPHTHALMIC 9.5MM ULTRAFIT SET DONOR CORONET STERILE DISPOSABLE|UMR [2035]|UMR OPTIONS [203501]|279.20||||279.20|||
100276|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|PUNCH OPHTHALMIC 9.5MM ULTRAFIT SET DONOR CORONET STERILE DISPOSABLE|MULTIPLAN [1680]|HMA [168003]|279.20||||279.20|||
100277|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|ADAPTER AIRWAY CAPNOFLEX LOW FLOW DEHUMIDIFICATION TUBE LATEX FREE|SAMBA HEALTH [2305]|SAMBA HEALTH [230500]|57.04||||57.04|39.93|51.34|11.98
100277|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|ADAPTER AIRWAY CAPNOFLEX LOW FLOW DEHUMIDIFICATION TUBE LATEX FREE|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|57.04||||57.04|51.34|51.34|11.98
100277|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|ADAPTER AIRWAY CAPNOFLEX LOW FLOW DEHUMIDIFICATION TUBE LATEX FREE|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|57.04||||57.04|51.34|51.34|11.98
100277|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|ADAPTER AIRWAY CAPNOFLEX LOW FLOW DEHUMIDIFICATION TUBE LATEX FREE|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|57.04||||57.04|51.34|51.34|11.98
100277|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|ADAPTER AIRWAY CAPNOFLEX LOW FLOW DEHUMIDIFICATION TUBE LATEX FREE|TRUSTMARK [2030]|STARMARK [203000]|57.04||||57.04|51.34|51.34|11.98
100277|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|ADAPTER AIRWAY CAPNOFLEX LOW FLOW DEHUMIDIFICATION TUBE LATEX FREE|GROUP PENSION ADMIN [1450]|GPA [145000]|57.04||||57.04|39.93|51.34|11.98
100277|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|ADAPTER AIRWAY CAPNOFLEX LOW FLOW DEHUMIDIFICATION TUBE LATEX FREE|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|57.04||||57.04|51.34|51.34|11.98
100277|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|ADAPTER AIRWAY CAPNOFLEX LOW FLOW DEHUMIDIFICATION TUBE LATEX FREE|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|57.04||||57.04|51.34|51.34|11.98
100277|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|ADAPTER AIRWAY CAPNOFLEX LOW FLOW DEHUMIDIFICATION TUBE LATEX FREE|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|57.04||||57.04|24.53|51.34|11.98
100277|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|ADAPTER AIRWAY CAPNOFLEX LOW FLOW DEHUMIDIFICATION TUBE LATEX FREE|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|57.04||||57.04|51.34|51.34|11.98
100277|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|ADAPTER AIRWAY CAPNOFLEX LOW FLOW DEHUMIDIFICATION TUBE LATEX FREE|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|57.04||||57.04|37.08|51.34|11.98
100277|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|ADAPTER AIRWAY CAPNOFLEX LOW FLOW DEHUMIDIFICATION TUBE LATEX FREE|AETNA [1015]|COVENTRY HEALTHCARE [101502]|57.04||||57.04|51.34|51.34|11.98
100277|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|ADAPTER AIRWAY CAPNOFLEX LOW FLOW DEHUMIDIFICATION TUBE LATEX FREE|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|57.04||||57.04|37.08|51.34|11.98
100277|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|ADAPTER AIRWAY CAPNOFLEX LOW FLOW DEHUMIDIFICATION TUBE LATEX FREE|AETNA [1015]|AMERICAN CONTINENTAL [101507]|57.04||||57.04|39.93|51.34|11.98
100277|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|ADAPTER AIRWAY CAPNOFLEX LOW FLOW DEHUMIDIFICATION TUBE LATEX FREE|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|57.04||||57.04|23.1|51.34|11.98
100277|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|ADAPTER AIRWAY CAPNOFLEX LOW FLOW DEHUMIDIFICATION TUBE LATEX FREE|FIRST HEALTH [1375]|BENVEO/UCS [137512]|57.04||||57.04|48.48|51.34|11.98
100277|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|ADAPTER AIRWAY CAPNOFLEX LOW FLOW DEHUMIDIFICATION TUBE LATEX FREE|FIRST HEALTH [1375]|QUALCHOICE [137513]|57.04||||57.04|51.34|51.34|11.98
100277|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|ADAPTER AIRWAY CAPNOFLEX LOW FLOW DEHUMIDIFICATION TUBE LATEX FREE|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|57.04||||57.04|51.34|51.34|11.98
100277|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|ADAPTER AIRWAY CAPNOFLEX LOW FLOW DEHUMIDIFICATION TUBE LATEX FREE|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|57.04||||57.04|33.03|51.34|11.98
100277|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|ADAPTER AIRWAY CAPNOFLEX LOW FLOW DEHUMIDIFICATION TUBE LATEX FREE|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|57.04||||57.04|28.06|51.34|11.98
100277|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|ADAPTER AIRWAY CAPNOFLEX LOW FLOW DEHUMIDIFICATION TUBE LATEX FREE|<Self-pay>|<Self-pay>|57.04||||57.04|17.11|51.34|11.98
100277|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|ADAPTER AIRWAY CAPNOFLEX LOW FLOW DEHUMIDIFICATION TUBE LATEX FREE|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|57.04||||57.04|37.08|51.34|11.98
100277|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|ADAPTER AIRWAY CAPNOFLEX LOW FLOW DEHUMIDIFICATION TUBE LATEX FREE|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|57.04||||57.04|51.34|51.34|11.98
100277|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|ADAPTER AIRWAY CAPNOFLEX LOW FLOW DEHUMIDIFICATION TUBE LATEX FREE|FMH BENEFIT SERVICES [1390]|FMH [139000]|57.04||||57.04|51.34|51.34|11.98
100277|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|ADAPTER AIRWAY CAPNOFLEX LOW FLOW DEHUMIDIFICATION TUBE LATEX FREE|CORESOURCE [1315]|CORESOURCE [131500]|57.04||||57.04|51.34|51.34|11.98
100277|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|ADAPTER AIRWAY CAPNOFLEX LOW FLOW DEHUMIDIFICATION TUBE LATEX FREE|CIGNA [1260]|CIGNA - GREAT WEST [126009]|57.04||||57.04|39.93|51.34|11.98
100277|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|ADAPTER AIRWAY CAPNOFLEX LOW FLOW DEHUMIDIFICATION TUBE LATEX FREE|MULTIPLAN [1680]|IHC HS [168011]|57.04||||57.04|51.34|51.34|11.98
100277|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|ADAPTER AIRWAY CAPNOFLEX LOW FLOW DEHUMIDIFICATION TUBE LATEX FREE|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|57.04||||57.04|51.34|51.34|11.98
100277|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|ADAPTER AIRWAY CAPNOFLEX LOW FLOW DEHUMIDIFICATION TUBE LATEX FREE|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|57.04||||57.04|51.34|51.34|11.98
100277|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|ADAPTER AIRWAY CAPNOFLEX LOW FLOW DEHUMIDIFICATION TUBE LATEX FREE|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|57.04||||57.04|18.82|51.34|11.98
100277|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|ADAPTER AIRWAY CAPNOFLEX LOW FLOW DEHUMIDIFICATION TUBE LATEX FREE|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|57.04||||57.04|51.34|51.34|11.98
100277|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|ADAPTER AIRWAY CAPNOFLEX LOW FLOW DEHUMIDIFICATION TUBE LATEX FREE|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|57.04||||57.04|24.53|51.34|11.98
100277|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|ADAPTER AIRWAY CAPNOFLEX LOW FLOW DEHUMIDIFICATION TUBE LATEX FREE|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|57.04||||57.04|51.34|51.34|11.98
100277|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|ADAPTER AIRWAY CAPNOFLEX LOW FLOW DEHUMIDIFICATION TUBE LATEX FREE|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|57.04||||57.04|28.52|51.34|11.98
100277|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|ADAPTER AIRWAY CAPNOFLEX LOW FLOW DEHUMIDIFICATION TUBE LATEX FREE|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|57.04||||57.04|51.34|51.34|11.98
100277|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|ADAPTER AIRWAY CAPNOFLEX LOW FLOW DEHUMIDIFICATION TUBE LATEX FREE|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|57.04||||57.04|18.2|51.34|11.98
100277|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|ADAPTER AIRWAY CAPNOFLEX LOW FLOW DEHUMIDIFICATION TUBE LATEX FREE|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|57.04||||57.04|43.92|51.34|11.98
100277|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|ADAPTER AIRWAY CAPNOFLEX LOW FLOW DEHUMIDIFICATION TUBE LATEX FREE|HEALTHNET [1495]|HEALTHNET [149500]|57.04||||57.04|51.34|51.34|11.98
100277|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|ADAPTER AIRWAY CAPNOFLEX LOW FLOW DEHUMIDIFICATION TUBE LATEX FREE|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|57.04||||57.04|51.34|51.34|11.98
100277|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|ADAPTER AIRWAY CAPNOFLEX LOW FLOW DEHUMIDIFICATION TUBE LATEX FREE|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|57.04||||57.04|11.98|51.34|11.98
100277|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|ADAPTER AIRWAY CAPNOFLEX LOW FLOW DEHUMIDIFICATION TUBE LATEX FREE|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|57.04||||57.04|51.34|51.34|11.98
100277|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|ADAPTER AIRWAY CAPNOFLEX LOW FLOW DEHUMIDIFICATION TUBE LATEX FREE|UMR [2035]|UMR OPTIONS [203501]|57.04||||57.04|||
100277|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|ADAPTER AIRWAY CAPNOFLEX LOW FLOW DEHUMIDIFICATION TUBE LATEX FREE|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|57.04||||57.04|||
100277|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|ADAPTER AIRWAY CAPNOFLEX LOW FLOW DEHUMIDIFICATION TUBE LATEX FREE|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|57.04||||57.04|||
100277|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|ADAPTER AIRWAY CAPNOFLEX LOW FLOW DEHUMIDIFICATION TUBE LATEX FREE|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|57.04||||57.04|||
100277|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|ADAPTER AIRWAY CAPNOFLEX LOW FLOW DEHUMIDIFICATION TUBE LATEX FREE|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|57.04||||57.04|||
100277|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|ADAPTER AIRWAY CAPNOFLEX LOW FLOW DEHUMIDIFICATION TUBE LATEX FREE|UNITED HEALTHCARE [2060]|UHC MEDICA CHOICE [206030]|57.04||||57.04|||
100277|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|ADAPTER AIRWAY CAPNOFLEX LOW FLOW DEHUMIDIFICATION TUBE LATEX FREE|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|57.04||||57.04|||
100277|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|ADAPTER AIRWAY CAPNOFLEX LOW FLOW DEHUMIDIFICATION TUBE LATEX FREE|MULTIPLAN [1680]|HMA [168003]|57.04||||57.04|||
100277|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|ADAPTER AIRWAY CAPNOFLEX LOW FLOW DEHUMIDIFICATION TUBE LATEX FREE|AETNA [1015]|AETNA ACO WILCO [101532]|57.04||||57.04|||
100277|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|ADAPTER AIRWAY CAPNOFLEX LOW FLOW DEHUMIDIFICATION TUBE LATEX FREE|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|57.04||||57.04|||
100277|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|ADAPTER AIRWAY CAPNOFLEX LOW FLOW DEHUMIDIFICATION TUBE LATEX FREE|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|57.04||||57.04|||
100277|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|ADAPTER AIRWAY CAPNOFLEX LOW FLOW DEHUMIDIFICATION TUBE LATEX FREE|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|57.04||||57.04|||
100277|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|ADAPTER AIRWAY CAPNOFLEX LOW FLOW DEHUMIDIFICATION TUBE LATEX FREE|GEHA [1415]|GEHA - ASA [141503]|57.04||||57.04|||
100277|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|ADAPTER AIRWAY CAPNOFLEX LOW FLOW DEHUMIDIFICATION TUBE LATEX FREE|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|57.04||||57.04|||
100277|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|ADAPTER AIRWAY CAPNOFLEX LOW FLOW DEHUMIDIFICATION TUBE LATEX FREE|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|57.04||||57.04|||
100277|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|ADAPTER AIRWAY CAPNOFLEX LOW FLOW DEHUMIDIFICATION TUBE LATEX FREE|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|57.04||||57.04|||
100277|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|ADAPTER AIRWAY CAPNOFLEX LOW FLOW DEHUMIDIFICATION TUBE LATEX FREE|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|57.04||||57.04|||
100277|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|ADAPTER AIRWAY CAPNOFLEX LOW FLOW DEHUMIDIFICATION TUBE LATEX FREE|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|57.04||||57.04|||
100277|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|ADAPTER AIRWAY CAPNOFLEX LOW FLOW DEHUMIDIFICATION TUBE LATEX FREE|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|57.04||||57.04|||
100277|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|ADAPTER AIRWAY CAPNOFLEX LOW FLOW DEHUMIDIFICATION TUBE LATEX FREE|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|57.04||||57.04|||
100277|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|ADAPTER AIRWAY CAPNOFLEX LOW FLOW DEHUMIDIFICATION TUBE LATEX FREE|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|57.04||||57.04|||
100277|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|ADAPTER AIRWAY CAPNOFLEX LOW FLOW DEHUMIDIFICATION TUBE LATEX FREE|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|57.04||||57.04|||
100277|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|ADAPTER AIRWAY CAPNOFLEX LOW FLOW DEHUMIDIFICATION TUBE LATEX FREE|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|57.04||||57.04|||
100277|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|ADAPTER AIRWAY CAPNOFLEX LOW FLOW DEHUMIDIFICATION TUBE LATEX FREE|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|57.04||||57.04|||
100277|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|ADAPTER AIRWAY CAPNOFLEX LOW FLOW DEHUMIDIFICATION TUBE LATEX FREE|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|57.04||||57.04|||
100277|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|ADAPTER AIRWAY CAPNOFLEX LOW FLOW DEHUMIDIFICATION TUBE LATEX FREE|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|57.04||||57.04|||
100277|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|ADAPTER AIRWAY CAPNOFLEX LOW FLOW DEHUMIDIFICATION TUBE LATEX FREE|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|57.04||||57.04|||
100277|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|ADAPTER AIRWAY CAPNOFLEX LOW FLOW DEHUMIDIFICATION TUBE LATEX FREE|CHAMPVA [1240]|CHAMP VA [124000]|57.04||||57.04|||
100277|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|ADAPTER AIRWAY CAPNOFLEX LOW FLOW DEHUMIDIFICATION TUBE LATEX FREE|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|57.04||||57.04|||
100277|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|ADAPTER AIRWAY CAPNOFLEX LOW FLOW DEHUMIDIFICATION TUBE LATEX FREE|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|57.04||||57.04|||
100278|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STENT PANCREATIC ADVANIX NAVIFLEX POLYMER STRAIGHT L9 CM OD5 FR RADIOPAQUE TRAIL ENDO MARKER COLOR CODED LEAD BARB STERILE ACCEPTS .035 IN GUIDEWIRE|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|300.00||||300.00|129|270|63
100278|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STENT PANCREATIC ADVANIX NAVIFLEX POLYMER STRAIGHT L9 CM OD5 FR RADIOPAQUE TRAIL ENDO MARKER COLOR CODED LEAD BARB STERILE ACCEPTS .035 IN GUIDEWIRE|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|300.00||||300.00|150|270|63
100278|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STENT PANCREATIC ADVANIX NAVIFLEX POLYMER STRAIGHT L9 CM OD5 FR RADIOPAQUE TRAIL ENDO MARKER COLOR CODED LEAD BARB STERILE ACCEPTS .035 IN GUIDEWIRE|HEALTHNET [1495]|HEALTHNET [149500]|300.00||||300.00|270|270|63
100278|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STENT PANCREATIC ADVANIX NAVIFLEX POLYMER STRAIGHT L9 CM OD5 FR RADIOPAQUE TRAIL ENDO MARKER COLOR CODED LEAD BARB STERILE ACCEPTS .035 IN GUIDEWIRE|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|300.00||||300.00|270|270|63
100278|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STENT PANCREATIC ADVANIX NAVIFLEX POLYMER STRAIGHT L9 CM OD5 FR RADIOPAQUE TRAIL ENDO MARKER COLOR CODED LEAD BARB STERILE ACCEPTS .035 IN GUIDEWIRE|MAGELLAN BEHAVIORAL COMMERCIAL [2895]|MAGELLAN BEHAVORIAL COMMERCIAL [289500]|300.00||||300.00|195|270|63
100278|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STENT PANCREATIC ADVANIX NAVIFLEX POLYMER STRAIGHT L9 CM OD5 FR RADIOPAQUE TRAIL ENDO MARKER COLOR CODED LEAD BARB STERILE ACCEPTS .035 IN GUIDEWIRE|CIGNA [1260]|CIGNA - GREAT WEST [126009]|300.00||||300.00|210|270|63
100278|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STENT PANCREATIC ADVANIX NAVIFLEX POLYMER STRAIGHT L9 CM OD5 FR RADIOPAQUE TRAIL ENDO MARKER COLOR CODED LEAD BARB STERILE ACCEPTS .035 IN GUIDEWIRE|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|300.00||||300.00|270|270|63
100278|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STENT PANCREATIC ADVANIX NAVIFLEX POLYMER STRAIGHT L9 CM OD5 FR RADIOPAQUE TRAIL ENDO MARKER COLOR CODED LEAD BARB STERILE ACCEPTS .035 IN GUIDEWIRE|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|300.00||||300.00|95.7|270|63
100278|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STENT PANCREATIC ADVANIX NAVIFLEX POLYMER STRAIGHT L9 CM OD5 FR RADIOPAQUE TRAIL ENDO MARKER COLOR CODED LEAD BARB STERILE ACCEPTS .035 IN GUIDEWIRE|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|300.00||||300.00|270|270|63
100278|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STENT PANCREATIC ADVANIX NAVIFLEX POLYMER STRAIGHT L9 CM OD5 FR RADIOPAQUE TRAIL ENDO MARKER COLOR CODED LEAD BARB STERILE ACCEPTS .035 IN GUIDEWIRE|BCBS [1155]|BLUE CROSS BLUE COMMUNITY HMO OF NM [115528]|300.00||||300.00|121.5|270|63
100278|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STENT PANCREATIC ADVANIX NAVIFLEX POLYMER STRAIGHT L9 CM OD5 FR RADIOPAQUE TRAIL ENDO MARKER COLOR CODED LEAD BARB STERILE ACCEPTS .035 IN GUIDEWIRE|NATIONAL TELEPHONE COOPERATIVE [1700]|NATIONAL TELEPHONE COOP ASSO [170000]|300.00||||300.00|270|270|63
100278|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STENT PANCREATIC ADVANIX NAVIFLEX POLYMER STRAIGHT L9 CM OD5 FR RADIOPAQUE TRAIL ENDO MARKER COLOR CODED LEAD BARB STERILE ACCEPTS .035 IN GUIDEWIRE|BCBS [1155]|BLUE CROSS PREFERRED OF NEW MEXICO [115529]|300.00||||300.00|147.6|270|63
100278|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STENT PANCREATIC ADVANIX NAVIFLEX POLYMER STRAIGHT L9 CM OD5 FR RADIOPAQUE TRAIL ENDO MARKER COLOR CODED LEAD BARB STERILE ACCEPTS .035 IN GUIDEWIRE|AMERICAN MEDICAL SECURITY [2190]|AMERICAN MEDICAL SECURITY [219000]|300.00||||300.00|270|270|63
100278|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STENT PANCREATIC ADVANIX NAVIFLEX POLYMER STRAIGHT L9 CM OD5 FR RADIOPAQUE TRAIL ENDO MARKER COLOR CODED LEAD BARB STERILE ACCEPTS .035 IN GUIDEWIRE|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|300.00||||300.00|270|270|63
100278|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STENT PANCREATIC ADVANIX NAVIFLEX POLYMER STRAIGHT L9 CM OD5 FR RADIOPAQUE TRAIL ENDO MARKER COLOR CODED LEAD BARB STERILE ACCEPTS .035 IN GUIDEWIRE|CORESOURCE [1315]|CORESOURCE [131500]|300.00||||300.00|270|270|63
100278|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STENT PANCREATIC ADVANIX NAVIFLEX POLYMER STRAIGHT L9 CM OD5 FR RADIOPAQUE TRAIL ENDO MARKER COLOR CODED LEAD BARB STERILE ACCEPTS .035 IN GUIDEWIRE|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|300.00||||300.00|270|270|63
100278|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STENT PANCREATIC ADVANIX NAVIFLEX POLYMER STRAIGHT L9 CM OD5 FR RADIOPAQUE TRAIL ENDO MARKER COLOR CODED LEAD BARB STERILE ACCEPTS .035 IN GUIDEWIRE|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|300.00||||300.00|270|270|63
100278|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STENT PANCREATIC ADVANIX NAVIFLEX POLYMER STRAIGHT L9 CM OD5 FR RADIOPAQUE TRAIL ENDO MARKER COLOR CODED LEAD BARB STERILE ACCEPTS .035 IN GUIDEWIRE|THE HEALTH PLAN [2915]|THE HEALTH PLAN [291500]|300.00||||300.00|63|270|63
100278|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STENT PANCREATIC ADVANIX NAVIFLEX POLYMER STRAIGHT L9 CM OD5 FR RADIOPAQUE TRAIL ENDO MARKER COLOR CODED LEAD BARB STERILE ACCEPTS .035 IN GUIDEWIRE|BCBS [1155]|BLUE CROSS IMAGINE HEALTH OF NEW MEXICO [115527]|300.00||||300.00|129|270|63
100278|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STENT PANCREATIC ADVANIX NAVIFLEX POLYMER STRAIGHT L9 CM OD5 FR RADIOPAQUE TRAIL ENDO MARKER COLOR CODED LEAD BARB STERILE ACCEPTS .035 IN GUIDEWIRE|FMH BENEFIT SERVICES [1390]|FMH [139000]|300.00||||300.00|270|270|63
100278|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STENT PANCREATIC ADVANIX NAVIFLEX POLYMER STRAIGHT L9 CM OD5 FR RADIOPAQUE TRAIL ENDO MARKER COLOR CODED LEAD BARB STERILE ACCEPTS .035 IN GUIDEWIRE|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|300.00||||300.00|99|270|63
100278|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STENT PANCREATIC ADVANIX NAVIFLEX POLYMER STRAIGHT L9 CM OD5 FR RADIOPAQUE TRAIL ENDO MARKER COLOR CODED LEAD BARB STERILE ACCEPTS .035 IN GUIDEWIRE|BCBS [1155]|BLUE CROSS TRADITIONAL OF NEW MEXICO [115513]|300.00||||300.00|173.7|270|63
100278|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STENT PANCREATIC ADVANIX NAVIFLEX POLYMER STRAIGHT L9 CM OD5 FR RADIOPAQUE TRAIL ENDO MARKER COLOR CODED LEAD BARB STERILE ACCEPTS .035 IN GUIDEWIRE|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|300.00||||300.00|270|270|63
100278|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STENT PANCREATIC ADVANIX NAVIFLEX POLYMER STRAIGHT L9 CM OD5 FR RADIOPAQUE TRAIL ENDO MARKER COLOR CODED LEAD BARB STERILE ACCEPTS .035 IN GUIDEWIRE|HEALTHSMART [1505]|HEALTHSMART PREFERRED CARE (HSPC) [150500]|300.00||||300.00|231|270|63
100278|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STENT PANCREATIC ADVANIX NAVIFLEX POLYMER STRAIGHT L9 CM OD5 FR RADIOPAQUE TRAIL ENDO MARKER COLOR CODED LEAD BARB STERILE ACCEPTS .035 IN GUIDEWIRE|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|300.00||||300.00|150|270|63
100278|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STENT PANCREATIC ADVANIX NAVIFLEX POLYMER STRAIGHT L9 CM OD5 FR RADIOPAQUE TRAIL ENDO MARKER COLOR CODED LEAD BARB STERILE ACCEPTS .035 IN GUIDEWIRE|AETNA [1015]|COVENTRY HEALTHCARE [101502]|300.00||||300.00|270|270|63
100278|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STENT PANCREATIC ADVANIX NAVIFLEX POLYMER STRAIGHT L9 CM OD5 FR RADIOPAQUE TRAIL ENDO MARKER COLOR CODED LEAD BARB STERILE ACCEPTS .035 IN GUIDEWIRE|<Self-pay>|<Self-pay>|300.00||||300.00|90|270|63
100278|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STENT PANCREATIC ADVANIX NAVIFLEX POLYMER STRAIGHT L9 CM OD5 FR RADIOPAQUE TRAIL ENDO MARKER COLOR CODED LEAD BARB STERILE ACCEPTS .035 IN GUIDEWIRE|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|300.00||||300.00|270|270|63
100278|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STENT PANCREATIC ADVANIX NAVIFLEX POLYMER STRAIGHT L9 CM OD5 FR RADIOPAQUE TRAIL ENDO MARKER COLOR CODED LEAD BARB STERILE ACCEPTS .035 IN GUIDEWIRE|FIRST HEALTH [1375]|QUALCHOICE [137513]|300.00||||300.00|270|270|63
100278|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STENT PANCREATIC ADVANIX NAVIFLEX POLYMER STRAIGHT L9 CM OD5 FR RADIOPAQUE TRAIL ENDO MARKER COLOR CODED LEAD BARB STERILE ACCEPTS .035 IN GUIDEWIRE|FIRST HEALTH [1375]|BENVEO/UCS [137512]|300.00||||300.00|255|270|63
100278|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STENT PANCREATIC ADVANIX NAVIFLEX POLYMER STRAIGHT L9 CM OD5 FR RADIOPAQUE TRAIL ENDO MARKER COLOR CODED LEAD BARB STERILE ACCEPTS .035 IN GUIDEWIRE|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|300.00||||300.00|195|270|63
100278|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STENT PANCREATIC ADVANIX NAVIFLEX POLYMER STRAIGHT L9 CM OD5 FR RADIOPAQUE TRAIL ENDO MARKER COLOR CODED LEAD BARB STERILE ACCEPTS .035 IN GUIDEWIRE|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|300.00||||300.00|270|270|63
100278|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STENT PANCREATIC ADVANIX NAVIFLEX POLYMER STRAIGHT L9 CM OD5 FR RADIOPAQUE TRAIL ENDO MARKER COLOR CODED LEAD BARB STERILE ACCEPTS .035 IN GUIDEWIRE|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|300.00||||300.00|195|270|63
100278|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STENT PANCREATIC ADVANIX NAVIFLEX POLYMER STRAIGHT L9 CM OD5 FR RADIOPAQUE TRAIL ENDO MARKER COLOR CODED LEAD BARB STERILE ACCEPTS .035 IN GUIDEWIRE|AETNA [1015]|AMERICAN CONTINENTAL [101507]|300.00||||300.00|210|270|63
100278|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STENT PANCREATIC ADVANIX NAVIFLEX POLYMER STRAIGHT L9 CM OD5 FR RADIOPAQUE TRAIL ENDO MARKER COLOR CODED LEAD BARB STERILE ACCEPTS .035 IN GUIDEWIRE|SAMBA HEALTH [2305]|SAMBA HEALTH [230500]|300.00||||300.00|210|270|63
100278|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STENT PANCREATIC ADVANIX NAVIFLEX POLYMER STRAIGHT L9 CM OD5 FR RADIOPAQUE TRAIL ENDO MARKER COLOR CODED LEAD BARB STERILE ACCEPTS .035 IN GUIDEWIRE|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|300.00||||300.00|270|270|63
100278|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STENT PANCREATIC ADVANIX NAVIFLEX POLYMER STRAIGHT L9 CM OD5 FR RADIOPAQUE TRAIL ENDO MARKER COLOR CODED LEAD BARB STERILE ACCEPTS .035 IN GUIDEWIRE|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|300.00||||300.00|270|270|63
100278|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STENT PANCREATIC ADVANIX NAVIFLEX POLYMER STRAIGHT L9 CM OD5 FR RADIOPAQUE TRAIL ENDO MARKER COLOR CODED LEAD BARB STERILE ACCEPTS .035 IN GUIDEWIRE|MULTIPLAN [1680]|IHC HS [168011]|300.00||||300.00|270|270|63
100278|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STENT PANCREATIC ADVANIX NAVIFLEX POLYMER STRAIGHT L9 CM OD5 FR RADIOPAQUE TRAIL ENDO MARKER COLOR CODED LEAD BARB STERILE ACCEPTS .035 IN GUIDEWIRE|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|300.00||||300.00|270|270|63
100278|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STENT PANCREATIC ADVANIX NAVIFLEX POLYMER STRAIGHT L9 CM OD5 FR RADIOPAQUE TRAIL ENDO MARKER COLOR CODED LEAD BARB STERILE ACCEPTS .035 IN GUIDEWIRE|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|300.00||||300.00|270|270|63
100278|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STENT PANCREATIC ADVANIX NAVIFLEX POLYMER STRAIGHT L9 CM OD5 FR RADIOPAQUE TRAIL ENDO MARKER COLOR CODED LEAD BARB STERILE ACCEPTS .035 IN GUIDEWIRE|TRUSTMARK [2030]|STARMARK [203000]|300.00||||300.00|270|270|63
100278|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STENT PANCREATIC ADVANIX NAVIFLEX POLYMER STRAIGHT L9 CM OD5 FR RADIOPAQUE TRAIL ENDO MARKER COLOR CODED LEAD BARB STERILE ACCEPTS .035 IN GUIDEWIRE|GROUP PENSION ADMIN [1450]|GPA [145000]|300.00||||300.00|210|270|63
100278|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STENT PANCREATIC ADVANIX NAVIFLEX POLYMER STRAIGHT L9 CM OD5 FR RADIOPAQUE TRAIL ENDO MARKER COLOR CODED LEAD BARB STERILE ACCEPTS .035 IN GUIDEWIRE|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|300.00||||300.00|||
100278|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STENT PANCREATIC ADVANIX NAVIFLEX POLYMER STRAIGHT L9 CM OD5 FR RADIOPAQUE TRAIL ENDO MARKER COLOR CODED LEAD BARB STERILE ACCEPTS .035 IN GUIDEWIRE|BCBS MEDICAID [1165]|BLUE CROSS CENTENNIAL CARE NEW MEXICO [116500]|300.00||||300.00|||
100278|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STENT PANCREATIC ADVANIX NAVIFLEX POLYMER STRAIGHT L9 CM OD5 FR RADIOPAQUE TRAIL ENDO MARKER COLOR CODED LEAD BARB STERILE ACCEPTS .035 IN GUIDEWIRE|WESTERN SKY COMMUNITY CARE [2920]|WESTERN SKY COMMUNITY CARE [292000]|300.00||||300.00|||
100278|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STENT PANCREATIC ADVANIX NAVIFLEX POLYMER STRAIGHT L9 CM OD5 FR RADIOPAQUE TRAIL ENDO MARKER COLOR CODED LEAD BARB STERILE ACCEPTS .035 IN GUIDEWIRE|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|300.00||||300.00|||
100278|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STENT PANCREATIC ADVANIX NAVIFLEX POLYMER STRAIGHT L9 CM OD5 FR RADIOPAQUE TRAIL ENDO MARKER COLOR CODED LEAD BARB STERILE ACCEPTS .035 IN GUIDEWIRE|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|300.00||||300.00|||
100278|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STENT PANCREATIC ADVANIX NAVIFLEX POLYMER STRAIGHT L9 CM OD5 FR RADIOPAQUE TRAIL ENDO MARKER COLOR CODED LEAD BARB STERILE ACCEPTS .035 IN GUIDEWIRE|PRESBYTERIAN SENIOR HEALTH PLAN [1835]|PRESBYTERIAN SENIOR PLAN [183500]|300.00||||300.00|||
100278|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STENT PANCREATIC ADVANIX NAVIFLEX POLYMER STRAIGHT L9 CM OD5 FR RADIOPAQUE TRAIL ENDO MARKER COLOR CODED LEAD BARB STERILE ACCEPTS .035 IN GUIDEWIRE|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|300.00||||300.00|||
100278|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STENT PANCREATIC ADVANIX NAVIFLEX POLYMER STRAIGHT L9 CM OD5 FR RADIOPAQUE TRAIL ENDO MARKER COLOR CODED LEAD BARB STERILE ACCEPTS .035 IN GUIDEWIRE|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|300.00||||300.00|||
100278|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STENT PANCREATIC ADVANIX NAVIFLEX POLYMER STRAIGHT L9 CM OD5 FR RADIOPAQUE TRAIL ENDO MARKER COLOR CODED LEAD BARB STERILE ACCEPTS .035 IN GUIDEWIRE|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|300.00||||300.00|||
100278|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STENT PANCREATIC ADVANIX NAVIFLEX POLYMER STRAIGHT L9 CM OD5 FR RADIOPAQUE TRAIL ENDO MARKER COLOR CODED LEAD BARB STERILE ACCEPTS .035 IN GUIDEWIRE|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|300.00||||300.00|||
100278|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STENT PANCREATIC ADVANIX NAVIFLEX POLYMER STRAIGHT L9 CM OD5 FR RADIOPAQUE TRAIL ENDO MARKER COLOR CODED LEAD BARB STERILE ACCEPTS .035 IN GUIDEWIRE|NEW MEXICO HEALTH CONNECTIONS [2800]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [280000]|300.00||||300.00|||
100278|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STENT PANCREATIC ADVANIX NAVIFLEX POLYMER STRAIGHT L9 CM OD5 FR RADIOPAQUE TRAIL ENDO MARKER COLOR CODED LEAD BARB STERILE ACCEPTS .035 IN GUIDEWIRE|TOTAL COMMUNITY CARE [2245]|TOTAL COMM CARE MEDICARE REPL [224501]|300.00||||300.00|||
100278|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STENT PANCREATIC ADVANIX NAVIFLEX POLYMER STRAIGHT L9 CM OD5 FR RADIOPAQUE TRAIL ENDO MARKER COLOR CODED LEAD BARB STERILE ACCEPTS .035 IN GUIDEWIRE|CHRISTUS HEALTH PLAN [2330]|CHRISTUS HP GENERATIONS HMO [233000]|300.00||||300.00|||
100278|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STENT PANCREATIC ADVANIX NAVIFLEX POLYMER STRAIGHT L9 CM OD5 FR RADIOPAQUE TRAIL ENDO MARKER COLOR CODED LEAD BARB STERILE ACCEPTS .035 IN GUIDEWIRE|AETNA [1015]|AETNA ACO WILCO [101532]|300.00||||300.00|||
100278|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STENT PANCREATIC ADVANIX NAVIFLEX POLYMER STRAIGHT L9 CM OD5 FR RADIOPAQUE TRAIL ENDO MARKER COLOR CODED LEAD BARB STERILE ACCEPTS .035 IN GUIDEWIRE|MOLINA CENTENNIAL CARE [2255]|MOLINA CENTENNIAL CARE MEDICAID REPL [225500]|300.00||||300.00|||
100278|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STENT PANCREATIC ADVANIX NAVIFLEX POLYMER STRAIGHT L9 CM OD5 FR RADIOPAQUE TRAIL ENDO MARKER COLOR CODED LEAD BARB STERILE ACCEPTS .035 IN GUIDEWIRE|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|300.00||||300.00|||
100278|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STENT PANCREATIC ADVANIX NAVIFLEX POLYMER STRAIGHT L9 CM OD5 FR RADIOPAQUE TRAIL ENDO MARKER COLOR CODED LEAD BARB STERILE ACCEPTS .035 IN GUIDEWIRE|CHAMPVA [1240]|CHAMP VA [124000]|300.00||||300.00|||
100278|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STENT PANCREATIC ADVANIX NAVIFLEX POLYMER STRAIGHT L9 CM OD5 FR RADIOPAQUE TRAIL ENDO MARKER COLOR CODED LEAD BARB STERILE ACCEPTS .035 IN GUIDEWIRE|MULTIPLAN [1680]|NEW MEXICO HEALTH CONNECTIONS (NMHC) [168001]|300.00||||300.00|||
100278|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STENT PANCREATIC ADVANIX NAVIFLEX POLYMER STRAIGHT L9 CM OD5 FR RADIOPAQUE TRAIL ENDO MARKER COLOR CODED LEAD BARB STERILE ACCEPTS .035 IN GUIDEWIRE|GEHA [1415]|GEHA - ASA [141503]|300.00||||300.00|||
100278|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STENT PANCREATIC ADVANIX NAVIFLEX POLYMER STRAIGHT L9 CM OD5 FR RADIOPAQUE TRAIL ENDO MARKER COLOR CODED LEAD BARB STERILE ACCEPTS .035 IN GUIDEWIRE|UNITED HEALTHCARE [2060]|UHC MEDICA CHOICE [206030]|300.00||||300.00|||
100278|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STENT PANCREATIC ADVANIX NAVIFLEX POLYMER STRAIGHT L9 CM OD5 FR RADIOPAQUE TRAIL ENDO MARKER COLOR CODED LEAD BARB STERILE ACCEPTS .035 IN GUIDEWIRE|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|300.00||||300.00|||
100278|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STENT PANCREATIC ADVANIX NAVIFLEX POLYMER STRAIGHT L9 CM OD5 FR RADIOPAQUE TRAIL ENDO MARKER COLOR CODED LEAD BARB STERILE ACCEPTS .035 IN GUIDEWIRE|MULTIPLAN [1680]|HMA [168003]|300.00||||300.00|||
100278|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STENT PANCREATIC ADVANIX NAVIFLEX POLYMER STRAIGHT L9 CM OD5 FR RADIOPAQUE TRAIL ENDO MARKER COLOR CODED LEAD BARB STERILE ACCEPTS .035 IN GUIDEWIRE|MOLINA HEALTHCARE [1670]|MOLINA HEALTHCARE HIX [167001]|300.00||||300.00|||
100278|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STENT PANCREATIC ADVANIX NAVIFLEX POLYMER STRAIGHT L9 CM OD5 FR RADIOPAQUE TRAIL ENDO MARKER COLOR CODED LEAD BARB STERILE ACCEPTS .035 IN GUIDEWIRE|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC CENTENNIAL CARE MEDICAID REPL [225000]|300.00||||300.00|||
100278|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STENT PANCREATIC ADVANIX NAVIFLEX POLYMER STRAIGHT L9 CM OD5 FR RADIOPAQUE TRAIL ENDO MARKER COLOR CODED LEAD BARB STERILE ACCEPTS .035 IN GUIDEWIRE|WESTERN SKY COMMUNITY CARE MEDICARE [4020]|ALLWELL FROM WESTERN SKY COMMUNITY CARE [402000]|300.00||||300.00|||
100278|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STENT PANCREATIC ADVANIX NAVIFLEX POLYMER STRAIGHT L9 CM OD5 FR RADIOPAQUE TRAIL ENDO MARKER COLOR CODED LEAD BARB STERILE ACCEPTS .035 IN GUIDEWIRE|TRUE HEALTH NEW MEXICO [2810]|TRUE HEALTH NEW MEXICO [281000]|300.00||||300.00|||
100278|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STENT PANCREATIC ADVANIX NAVIFLEX POLYMER STRAIGHT L9 CM OD5 FR RADIOPAQUE TRAIL ENDO MARKER COLOR CODED LEAD BARB STERILE ACCEPTS .035 IN GUIDEWIRE|BCC BREAST CERVICAL CANCER [2940]|BCC BREAST CERVICAL CANCER [294000]|300.00||||300.00|||
100278|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STENT PANCREATIC ADVANIX NAVIFLEX POLYMER STRAIGHT L9 CM OD5 FR RADIOPAQUE TRAIL ENDO MARKER COLOR CODED LEAD BARB STERILE ACCEPTS .035 IN GUIDEWIRE|BCBS IPA PAYOR [2945]|BCBS BEHAVIORAL HEALTH [294500]|300.00||||300.00|||
100278|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STENT PANCREATIC ADVANIX NAVIFLEX POLYMER STRAIGHT L9 CM OD5 FR RADIOPAQUE TRAIL ENDO MARKER COLOR CODED LEAD BARB STERILE ACCEPTS .035 IN GUIDEWIRE|UMR [2035]|UMR OPTIONS [203501]|300.00||||300.00|||
100279|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|GUIDEWIRE ENDOSCOPIC STAINLESS STEEL PTFE COONS STRAIGHT TAPER L80 CM L15 CM OD.035 IN FLOPPY FLEXIBLE TIP HEAVY DUTY STERILE LATEX FREE DISPOSABLE|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|100.00||||100.00|90|90|21
100279|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|GUIDEWIRE ENDOSCOPIC STAINLESS STEEL PTFE COONS STRAIGHT TAPER L80 CM L15 CM OD.035 IN FLOPPY FLEXIBLE TIP HEAVY DUTY STERILE LATEX FREE DISPOSABLE|SAMBA HEALTH [2305]|SAMBA HEALTH [230500]|100.00||||100.00|70|90|21
100279|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|GUIDEWIRE ENDOSCOPIC STAINLESS STEEL PTFE COONS STRAIGHT TAPER L80 CM L15 CM OD.035 IN FLOPPY FLEXIBLE TIP HEAVY DUTY STERILE LATEX FREE DISPOSABLE|BOON-CHAPMAN [2375]|BOON-CHAPMAN [237501]|100.00||||100.00|90|90|21
100279|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|GUIDEWIRE ENDOSCOPIC STAINLESS STEEL PTFE COONS STRAIGHT TAPER L80 CM L15 CM OD.035 IN FLOPPY FLEXIBLE TIP HEAVY DUTY STERILE LATEX FREE DISPOSABLE|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|100.00||||100.00|65|90|21
100279|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|GUIDEWIRE ENDOSCOPIC STAINLESS STEEL PTFE COONS STRAIGHT TAPER L80 CM L15 CM OD.035 IN FLOPPY FLEXIBLE TIP HEAVY DUTY STERILE LATEX FREE DISPOSABLE|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|100.00||||100.00|90|90|21
100279|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|GUIDEWIRE ENDOSCOPIC STAINLESS STEEL PTFE COONS STRAIGHT TAPER L80 CM L15 CM OD.035 IN FLOPPY FLEXIBLE TIP HEAVY DUTY STERILE LATEX FREE DISPOSABLE|PRESBYTERIAN HEALTH PLAN [1830]|PRESBYTERIAN HIX [183001]|100.00||||100.00|65|90|21
100279|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|GUIDEWIRE ENDOSCOPIC STAINLESS STEEL PTFE COONS STRAIGHT TAPER L80 CM L15 CM OD.035 IN FLOPPY FLEXIBLE TIP HEAVY DUTY STERILE LATEX FREE DISPOSABLE|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|100.00||||100.00|90|90|21
100279|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|GUIDEWIRE ENDOSCOPIC STAINLESS STEEL PTFE COONS STRAIGHT TAPER L80 CM L15 CM OD.035 IN FLOPPY FLEXIBLE TIP HEAVY DUTY STERILE LATEX FREE DISPOSABLE|KAISER PERMANENTE [1560]|KAISER FOUNDATION HEALTH PLAN [156001]|100.00||||100.00|90|90|21
100279|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|GUIDEWIRE ENDOSCOPIC STAINLESS STEEL PTFE COONS STRAIGHT TAPER L80 CM L15 CM OD.035 IN FLOPPY FLEXIBLE TIP HEAVY DUTY STERILE LATEX FREE DISPOSABLE|MULTIPLAN [1680]|IHC HS [168011]|100.00||||100.00|90|90|21
100279|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|GUIDEWIRE ENDOSCOPIC STAINLESS STEEL PTFE COONS STRAIGHT TAPER L80 CM L15 CM OD.035 IN FLOPPY FLEXIBLE TIP HEAVY DUTY STERILE LATEX FREE DISPOSABLE|PAN AMERICAN LIFE I